MEDICARE: MICHAEL D MALONE MD

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	2086S0129X	Vascular Surgery Physician	35083959	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000329488	OTHER	OH	ANTHEM BC/BS
2	383693735027	OTHER	OH	CARESOURCE
3	5539685	OTHER	OH	AETNA
4	P00102611	OTHER	OH	RAILROAD CARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982650719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D MALONE MD

Provider Business Mailing Address
First Line	:	PO BOX 801143
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1143
Country	:	US
Telephone Number	:	573-331-5583
Fax Number	:	573-331-5079

Provider Business Practice Location Address
First Line	:	3250 GORDONVILLE RD STE 358
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-5095
Country	:	US
Telephone Number	:	573-331-3155
Fax Number	:	573-331-5096

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/01/2021

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Directions to “ MICHAEL D MALONE MD” Practice Location

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