Provider Demographics
NPI:1750385324
Name:MALISZEWSKI, BOGDAN F (MD)
Entity type:Individual
Prefix:
First Name:BOGDAN
Middle Name:F
Last Name:MALISZEWSKI
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 1:2804 REMINGTON GREEN CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1550
Mailing Address - Country:US
Mailing Address - Phone:850-385-4494
Mailing Address - Fax:
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066-4127
Practice Address - Country:US
Practice Address - Phone:386-294-1226
Practice Address - Fax:386-294-4218
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48021207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062843300Medicaid
FLE22872Medicare UPIN
FL08374BMedicare PIN
FL062843300Medicaid
FL08374YMedicare PIN