Provider Demographics
NPI:1235288754
Name:MALAMUD, MIKHAIL Y (SA-C)
Entity Type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:Y
Last Name:MALAMUD
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6091 S PARIS ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4120
Mailing Address - Country:US
Mailing Address - Phone:303-766-1666
Mailing Address - Fax:303-766-8630
Practice Address - Street 1:6091 S PARIS ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4120
Practice Address - Country:US
Practice Address - Phone:303-766-1666
Practice Address - Fax:303-766-8630
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92-109246ZC0007X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant