Provider Demographics
NPI:1467437673
Name:MALAZDREWICZ, EDWARD JOHN (AUD FAAA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:MALAZDREWICZ
Suffix:
Gender:M
Credentials:AUD FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 37TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7244
Mailing Address - Country:US
Mailing Address - Phone:701-852-6565
Mailing Address - Fax:701-838-9381
Practice Address - Street 1:1400 37TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7244
Practice Address - Country:US
Practice Address - Phone:701-852-6565
Practice Address - Fax:701-838-9381
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1149237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55823Medicaid
NDN716065Medicare PIN