MEDICARE: ALEKSANDER IVANOVICH MALAKHOV 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	207Q00000X	Family Medicine Physician	36698	TN

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	:	1780797035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSANDER IVANOVICH MALAKHOV M.D.

Provider Business Mailing Address
First Line	:	HIGHWAY 411 SOUTH
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-0308
Country	:	US
Telephone Number	:	423-338-2831
Fax Number	:	423-338-2833

Provider Business Practice Location Address
First Line	:	HIGHWAY 411 SOUTH
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-0308
Country	:	US
Telephone Number	:	423-338-2831
Fax Number	:	423-338-2833

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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