MEDICARE: GEORGE T MALY MD, LLC

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	207RC0000X	Cardiovascular Disease Physician	35081651	OH

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

General Provider Information

NPI Number	:	1306937180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE T MALY MD, LLC

Provider Business Mailing Address
First Line	:	3949 SUNFOREST CT
Second Line	:	SUITE #201
City	:	TOLEDO
State	:	OH
Zip	:	43623-4473
Country	:	US
Telephone Number	:	419-475-3635
Fax Number	:	419-475-3376

Provider Business Practice Location Address
First Line	:	3949 SUNFOREST CT
Second Line	:	SUITE #201
City	:	TOLEDO
State	:	OH
Zip	:	43623-4473
Country	:	US
Telephone Number	:	419-475-3635
Fax Number	:	419-475-3376

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE T MALY
Credential	:	MD
Telephone Number	:	419-475-3635

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/26/2014

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