MEDICARE: DR. TOYA VENETTA MALONE 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	2084N0400X	Neurology Physician	4301088006	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417961137	OTHER	MI	BCBSM - BRONSON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720297799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOYA VENETTA MALONE M.D.

Provider Business Mailing Address
First Line	:	7730 W CHEYENNE AVE STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8412
Country	:	US
Telephone Number	:	725-221-1568
Fax Number	:	725-333-9218

Provider Business Practice Location Address
First Line	:	7730 W CHEYENNE AVE STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8412
Country	:	US
Telephone Number	:	725-221-1568
Fax Number	:	725-333-9218

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/23/2024

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