Provider Demographics
NPI:1275582348
Name:MALO, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:MALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2828 CHICAGO AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1544
Mailing Address - Country:US
Mailing Address - Phone:612-863-5390
Mailing Address - Fax:612-863-2697
Practice Address - Street 1:2828 CHICAGO AVE
Practice Address - Street 2:STE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1544
Practice Address - Country:US
Practice Address - Phone:612-863-5390
Practice Address - Fax:612-863-2697
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23884207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0255502OtherPREFERRED ONE
MN64G46MAOtherBLUE CROSS
MN7425178OtherMEDICA
MN768243OtherAMERICAS PPO
MNHP13904OtherHEALTH PARTNERS