Provider Demographics
NPI:1255499653
Name:MALINICS, MICHAEL C (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MALINICS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3119
Mailing Address - Country:US
Mailing Address - Phone:203-709-7300
Mailing Address - Fax:203-709-4501
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-709-7300
Practice Address - Fax:203-709-4501
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000239207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001002394Medicaid
CT4250662OtherAETNA
CT020239-7359OtherCONNECTICARE
CT2V9983OtherHEALTHNET/COMMERCIAL
CTP00453279OtherRR MEDICARE
CT21-50233OtherUHC
CT21-50233OtherAMERICHOICE
CT1086984OtherUSA
CT1255499653Medicaid
CT040000239CT08OtherANTHEM BCBS CT
CT415474OtherWELLCARE
CTP3837931OtherOXFORD
CT060001839Medicare PIN
CT001002394Medicaid
CT060001839Medicare PIN