Provider Demographics
NPI:1851688345
Name:MALIN, DANIELLE LOUISE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LOUISE
Last Name:MALIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 TROTWOOD AVE STE 39
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4948
Mailing Address - Country:US
Mailing Address - Phone:931-901-0296
Mailing Address - Fax:931-901-0299
Practice Address - Street 1:1412 TROTWOOD AVE STE 39
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4948
Practice Address - Country:US
Practice Address - Phone:931-901-0296
Practice Address - Fax:931-901-0299
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN776213ES0103X
CTP911213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014246Medicaid
TNQ014246Medicaid
CT061280198OtherANTHEM BLUE CROSS
061280198OtherCIGNA
CT1083691414Medicaid
CTC01774Medicare PIN