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NPI Code Detail

MEDICARE: DR KELLY MALINOSKI LLC

MEDICARE: DR KELLY MALINOSKI 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
1213ES0103XFoot & Ankle Surgery PodiatristPO3475FL

General Provider Information

NPI Number : 1457628521
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR KELLY MALINOSKI LLC
Provider Business Mailing Address
First Line : 1333 3RD AVE S STE 504
Second Line :
City : NAPLES
State : FL
Zip : 34102-6538
Country : US
Telephone Number : 239-260-5181
Fax Number : 239-260-5183
Provider Business Practice Location Address
First Line : 1333 3RD AVE S STE 504
Second Line :
City : NAPLES
State : FL
Zip : 34102-6538
Country : US
Telephone Number : 239-260-5181
Fax Number : 239-260-5183
Authorized Official
Title or Position : OWNER
Name : KELLY ANN MALINOSKI
Credential :
Telephone Number : 239-260-5181
Provider Enumeration Date : 11/17/2011
Last Update Date : 08/19/2022

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