MEDICARE: KING MALONE III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1073123311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KING MALONE III

Provider Business Mailing Address
First Line	:	1193 E 172ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3153
Country	:	US
Telephone Number	:	216-970-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1193 E 172ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3153
Country	:	US
Telephone Number	:	216-970-3287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2020
Last Update Date	:	08/02/2020

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Directions to “ KING MALONE III ” Practice Location

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