Provider Demographics
NPI:1710966288
Name:MALTINSKI, GENADI (MD)
Entity Type:Individual
Prefix:MR
First Name:GENADI
Middle Name:
Last Name:MALTINSKI
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 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3131 LA CANADA ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-369-5582
Practice Address - Fax:702-650-5148
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38713-020207Q00000X
NV18514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326349135OtherCMH SB NPI
NV1710966288Medicaid
NV18514OtherSTATE LICENSE
WI1851477913OtherCMH NPI
WI1134250905OtherCMH PCC G NPI
WI521310Medicare Oscar/Certification
WIG57206Medicare UPIN