Provider Demographics
NPI:1891739058
Name:MALYSZEK, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:MALYSZEK
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 29048
Mailing Address - Street 2:MSC #830
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:719-635-2501
Mailing Address - Fax:719-632-1062
Practice Address - Street 1:2222 N NEVADA AVE STE 5017
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-635-2501
Practice Address - Fax:719-632-1062
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00456872086S0127X
CO45687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO810245OtherMEDICARE ID
CO32687559Medicaid
CO32687559Medicaid