Provider Demographics
NPI:1003819947
Name:MALLEY, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:630 NW ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3973
Mailing Address - Country:US
Mailing Address - Phone:816-453-2700
Mailing Address - Fax:816-453-9943
Practice Address - Street 1:630 NW ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3973
Practice Address - Country:US
Practice Address - Phone:816-453-2700
Practice Address - Fax:816-453-9943
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO367172085R0202X
KS04-226852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology