Provider Demographics
NPI:1073575098
Name:MALIKOWSKI, ANNA C (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:MALIKOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ELEANOR CT
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4603
Mailing Address - Country:US
Mailing Address - Phone:320-217-8705
Mailing Address - Fax:
Practice Address - Street 1:206 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1331
Practice Address - Country:US
Practice Address - Phone:320-253-0365
Practice Address - Fax:320-253-0365
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN530013400Medicaid
MNU98495Medicare UPIN
MN530013400Medicaid