Provider Demographics
NPI:1336141050
Name:MALCZEWSKI, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MALCZEWSKI
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 1:7865 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-945-0669
Mailing Address - Fax:219-945-5669
Practice Address - Street 1:7865 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-945-0669
Practice Address - Fax:219-945-5669
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043550A2086S0122X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200025060Medicaid
ING00519Medicare UPIN