MEDICARE: WILLIAM JOSEPH MALIVUK PA-C

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	363A00000X	Physician Assistant	0001-03512	NC

General Provider Information

NPI Number	:	1811916471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOSEPH MALIVUK PA-C

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-251-8824

Provider Business Practice Location Address
First Line	:	1333 S DICKINSON DR
Second Line	:	SUITE 140
City	:	LELAND
State	:	NC
Zip	:	28451-6430
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-341-3321

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/11/2014

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