Provider Demographics
NPI:1386862316
Name:MALSTROM, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:MALSTROM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GRANITE POINT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1992
Mailing Address - Country:US
Mailing Address - Phone:610-378-1344
Mailing Address - Fax:610-378-5169
Practice Address - Street 1:293 ARMAND HAMMER BLVD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-7002
Practice Address - Country:US
Practice Address - Phone:610-327-8528
Practice Address - Fax:610-327-4155
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-07-26
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Provider Licenses
StateLicense IDTaxonomies
PAMD433801207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021626190004Medicaid
PA1021626190001Medicaid