Provider Demographics
NPI:1619943149
Name:MALENKOS, JAMES III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MALENKOS
Suffix:III
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 1:5153 SAND HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923
Mailing Address - Country:US
Mailing Address - Phone:719-388-8466
Mailing Address - Fax:719-556-9677
Practice Address - Street 1:5153 SAND HILL DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923
Practice Address - Country:US
Practice Address - Phone:719-388-8466
Practice Address - Fax:719-556-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG75522083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine