Provider Demographics
NPI:1013066315
Name:BENDER, MALINDA J (MD)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:J
Last Name:BENDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4711
Mailing Address - Country:US
Mailing Address - Phone:402-955-7605
Mailing Address - Fax:402-955-7601
Practice Address - Street 1:4802 SHANNON DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68133-4711
Practice Address - Country:US
Practice Address - Phone:402-955-7605
Practice Address - Fax:402-955-7601
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026303200Medicaid
DC022063I67Medicare PIN