MEDICARE: DR. FRED S MALKOWSKI DDS

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	122300000X	Dentist	12006964A	IN

General Provider Information

NPI Number	:	1447382189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED S MALKOWSKI DDS

Provider Business Mailing Address
First Line	:	7441 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-2517
Country	:	US
Telephone Number	:	317-271-1028
Fax Number	:

Provider Business Practice Location Address
First Line	:	7441 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-2517
Country	:	US
Telephone Number	:	317-271-1028
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	05/15/2008

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