Provider Demographics
NPI:1720467194
Name:MALIKOWSKI, GRETCHEN LYNN (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LYNN
Last Name:MALIKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:LYNN
Other - Last Name:DELUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4949 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4013
Mailing Address - Country:US
Mailing Address - Phone:716-970-4140
Mailing Address - Fax:
Practice Address - Street 1:353 KENMORE AVE STE 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2925
Practice Address - Country:US
Practice Address - Phone:716-970-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305158207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology