Provider Demographics
NPI:1700846466
Name:MALEC, AVEN DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:AVEN
Middle Name:DAWN
Last Name:MALEC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6300 WILSON MILLS RD
Mailing Address - Street 2:W31
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2109
Mailing Address - Country:US
Mailing Address - Phone:855-893-1033
Mailing Address - Fax:855-529-7659
Practice Address - Street 1:6300 WILSON MILLS RD
Practice Address - Street 2:W31
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2109
Practice Address - Country:US
Practice Address - Phone:855-893-1033
Practice Address - Fax:855-529-7659
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH264200000OtherDEPT OF LABOR
OH6600162OtherUNITED HEALTHCARE
OH2472917Medicaid
OH80507OtherQUALCHOICE
OH000000339430OtherANTHEM
OH264200000OtherFEDERAL BLACK LUNG
OH2472917Medicaid