MEDICARE: ELIJAH MALLETT

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	372500000X	Chore Provider		OH

General Provider Information

NPI Number	:	1093564916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIJAH MALLETT

Provider Business Mailing Address
First Line	:	13407 LITTLETON RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5155
Country	:	US
Telephone Number	:	216-280-4965
Fax Number	:	216-280-4965

Provider Business Practice Location Address
First Line	:	13407 LITTLETON RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5155
Country	:	US
Telephone Number	:	216-280-4965
Fax Number	:	216-280-4965

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

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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Directions to “ ELIJAH MALLETT ” Practice Location

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