Provider Demographics
NPI:1073123311
Name:MALONE, KING III
Entity Type:Individual
Prefix:
First Name:KING
Middle Name:
Last Name:MALONE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 E 172ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-3153
Mailing Address - Country:US
Mailing Address - Phone:216-970-3287
Mailing Address - Fax:
Practice Address - Street 1:1193 E 172ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-3153
Practice Address - Country:US
Practice Address - Phone:216-970-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator