Provider Demographics
NPI:1437232287
Name:MALAVOLTI, TIMOTHY N (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:N
Last Name:MALAVOLTI
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 1:9318 S TOLEDO CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2746
Mailing Address - Country:US
Mailing Address - Phone:918-294-3668
Mailing Address - Fax:
Practice Address - Street 1:9318 S TOLEDO CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2746
Practice Address - Country:US
Practice Address - Phone:918-294-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK158213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP01770667OtherRAILROAD MEDICARE
OK100779850AMedicaid
OK100779850Medicaid
OK246802101Medicare PIN
OKP01770667OtherRAILROAD MEDICARE
OK100779850Medicaid