Provider Demographics
NPI:1780797035
Name:MALAKHOV, ALEKSANDER IVANOVICH (MD)
Entity type:Individual
Prefix:
First Name:ALEKSANDER
Middle Name:IVANOVICH
Last Name:MALAKHOV
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:HIGHWAY 411 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0308
Mailing Address - Country:US
Mailing Address - Phone:423-338-2831
Mailing Address - Fax:423-338-2833
Practice Address - Street 1:HIGHWAY 411 SOUTH
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-0308
Practice Address - Country:US
Practice Address - Phone:423-338-2831
Practice Address - Fax:423-338-2833
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879621Medicaid
TN3879621Medicare ID - Type Unspecified
TNF89706Medicare UPIN