MEDICARE: DR. MICHAEL C MALCZEWSKI M.D.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	01043550A	IN
2	2086S0105X	Surgery of the Hand (Surgery) Physician	01043550A	IN

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	:	1336141050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C MALCZEWSKI M.D.

Provider Business Mailing Address
First Line	:	7865 GRAND BLVD
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-6665
Country	:	US
Telephone Number	:	219-945-0669
Fax Number	:	219-945-5669

Provider Business Practice Location Address
First Line	:	7865 GRAND BLVD
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-6665
Country	:	US
Telephone Number	:	219-945-0669
Fax Number	:	219-945-5669

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/02/2009

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