Provider Demographics
NPI:1073597472
Name:MALMER, MICHAEL M (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:MALMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 MCCARTNEY RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-5000
Mailing Address - Country:US
Mailing Address - Phone:330-743-4440
Mailing Address - Fax:330-743-4488
Practice Address - Street 1:821 MCCARTNEY RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-5000
Practice Address - Country:US
Practice Address - Phone:330-743-4440
Practice Address - Fax:330-743-4488
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928009Medicaid
1083828974OtherORGANIZATIONAL NPI
1205958519OtherORGANIZATIONAL NPI
E81732OtherUPIN
1083828974OtherORGANIZATIONAL NPI
MA0856935Medicare PIN