Provider Demographics
NPI:1417198094
Name:MALINOSKI, KELLY ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:MALINOSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 3RD AVE S STE 504
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6538
Mailing Address - Country:US
Mailing Address - Phone:239-260-5181
Mailing Address - Fax:239-260-5183
Practice Address - Street 1:1333 3RD AVE S STE 504
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6538
Practice Address - Country:US
Practice Address - Phone:239-260-5181
Practice Address - Fax:239-260-5183
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3475213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFB336Medicare PIN