Provider Demographics
NPI:1932120581
Name:MALKOWSKI, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MALKOWSKI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:12 QUAKER VILLAGE SHOPPING CTR
Mailing Address - Street 2:OHIO RIVER BLVD STE 2
Mailing Address - City:LEETSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15056-1206
Mailing Address - Country:US
Mailing Address - Phone:724-773-4502
Mailing Address - Fax:412-749-6787
Practice Address - Street 1:12 QUAKER VILLAGE SHOPPING CTR
Practice Address - Street 2:OHIO RIVER BLVD STE 2
Practice Address - City:LEETSDALE
Practice Address - State:PA
Practice Address - Zip Code:15056-1206
Practice Address - Country:US
Practice Address - Phone:724-773-4502
Practice Address - Fax:412-749-6787
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043418L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015386900011Medicaid
PA0015386900011Medicaid
PA786066LCKMedicare PIN