Provider Demographics
NPI:1730101106
Name:MALINOWSKI, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:MALINOWSKI
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 1:24701 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-475-8844
Mailing Address - Fax:216-475-3816
Practice Address - Street 1:13201 GRANGER RD STE 2
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1979
Practice Address - Country:US
Practice Address - Phone:216-475-8844
Practice Address - Fax:216-475-3816
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2123491OtherBCMH
OH2123491Medicaid
OH2156576OtherAETNA
OH000000221398OtherUNISON
OH732591OtherBUCKEYE
OH363799OtherWELLCARE
OH000000182666OtherANTHEM
OH000000526085OtherANTHEM
OH2123491OtherBCMH
OH2156576OtherAETNA