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NPI Code Detail

MEDICARE: KEITH EDWARD MALLETT JR.

MEDICARE: KEITH EDWARD MALLETT JR.
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1578421640
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH EDWARD MALLETT JR.
Provider Business Mailing Address
First Line : 4653 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-3298
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4653 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-3298
Country : US
Telephone Number : 614-875-2371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ KEITH EDWARD MALLETT JR. ” Practice Location

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