Provider Demographics
NPI:1982671194
Name:MALITZ, DAVID I (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:MALITZ
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 1:1001 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1963
Mailing Address - Country:US
Mailing Address - Phone:812-421-2020
Mailing Address - Fax:812-422-1189
Practice Address - Street 1:1001 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1963
Practice Address - Country:US
Practice Address - Phone:812-421-2020
Practice Address - Fax:812-422-1189
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10979207W00000X
IN01041297207W00000X
KY30753207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100242920AMedicaid
KY64878085Medicaid
NV100510131Medicaid
KY0559602Medicare PIN
NVE83078Medicare UPIN
NV100510131Medicaid
IN635290AMedicare PIN