MEDICARE: HARRY DOUGLAS MALCOLM 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
1	207Q00000X	Family Medicine Physician	38164-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144251166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY DOUGLAS MALCOLM MD

Provider Business Mailing Address
First Line	:	9940 N COUNTY HWY K
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-2186
Country	:	US
Telephone Number	:	715-638-5100
Fax Number	:	715-634-6107

Provider Business Practice Location Address
First Line	:	9940 N COUNTY HWY K
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-2186
Country	:	US
Telephone Number	:	715-638-5100
Fax Number	:	715-634-6107

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/02/2025

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