Provider Demographics
NPI:1497979611
Name:MALECKI, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MALECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-8640
Mailing Address - Fax:704-384-8650
Practice Address - Street 1:3614 PROVIDENCE RD S
Practice Address - Street 2:SUITE 200
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6309
Practice Address - Country:US
Practice Address - Phone:704-384-8640
Practice Address - Fax:704-384-8650
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119584207Q00000X
NC2015-01614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine