Provider Demographics
NPI:1376256347
Name:MALAK, MELVIN JR
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:MALAK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3256
Mailing Address - Country:US
Mailing Address - Phone:419-450-0574
Mailing Address - Fax:
Practice Address - Street 1:6913 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3256
Practice Address - Country:US
Practice Address - Phone:419-450-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities