Provider Demographics
NPI:1144410291
Name:MALABANAN, MICHELLE HUSMILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HUSMILLO
Last Name:MALABANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2020 RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2300
Practice Address - Country:US
Practice Address - Phone:920-433-9920
Practice Address - Fax:920-433-9927
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI60162-20207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40120Medicare PIN