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NPI Code Detail

MEDICARE: DR. SUZANNE M MALIS MD

MEDICARE: DR. SUZANNE M MALIS MD
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
1207Q00000XFamily Medicine Physician41881CO

General Provider Information

NPI Number : 1083621429
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUZANNE M MALIS MD
Provider Business Mailing Address
First Line : 4024 SAN FELICE PT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-5900
Country : US
Telephone Number : 719-390-1727
Fax Number : 719-390-9690
Provider Business Practice Location Address
First Line : 2322 S ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-2406
Country : US
Telephone Number : 719-390-1727
Fax Number : 719-390-9690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 07/08/2007

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