Provider Demographics
NPI:1417401944
Name:NALAMLIENG, MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:NALAMLIENG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 14TH AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3368
Mailing Address - Country:US
Mailing Address - Phone:256-350-0362
Mailing Address - Fax:
Practice Address - Street 1:1107 14TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3368
Practice Address - Country:US
Practice Address - Phone:256-350-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL6682213ES0103X
AL387213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-78025OtherBLUE CROSS BLUE SHIELD ALABAMA
AL289893Medicaid