Provider Demographics
NPI:1942719513
Name:MAXIMILIAN MALOTKY, M.D., INC.
Entity Type:Organization
Organization Name:MAXIMILIAN MALOTKY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-638-8868
Mailing Address - Street 1:1800 BUENAVENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3700
Mailing Address - Country:US
Mailing Address - Phone:1530-638-8868
Mailing Address - Fax:
Practice Address - Street 1:1800 BUENAVENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3700
Practice Address - Country:US
Practice Address - Phone:1530-638-8868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148839208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty