Provider Demographics
NPI:1861461097
Name:MALLONEE, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:MALLONEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:2325 W ARBORS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2663
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC24453207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11545OtherWELLPATH
NC10474OtherKANAWHA
SCN24453Medicaid
SC000000293196OtherUNISON HEALTH PLAN SC
SC20097006OtherSELECT HEALTH OF SC
NC6194OtherDOCTORS HEALTH PLAN
SC01146098OtherAMERIGROUP OF SC
NC8953786Medicaid
NC53743OtherMEDCOST
NC6354OtherPARTNERS
NC1041433OtherUNITED HEALTHCARE
NC141020OtherCOVENTRY HEALTHCARE
NC276575OtherMAMSI
NC4066654OtherAETNA
SCN24453Medicaid
NC6354OtherPARTNERS
NC1041433OtherUNITED HEALTHCARE