Provider Demographics
NPI:1881691814
Name:MALONE, RICHARD K (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:MALONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:651 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5523
Mailing Address - Country:US
Mailing Address - Phone:812-333-2304
Mailing Address - Fax:812-330-2306
Practice Address - Street 1:651 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5523
Practice Address - Country:US
Practice Address - Phone:812-333-2304
Practice Address - Fax:812-330-2306
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100068670Medicaid
IN100068670Medicaid
INM400025783Medicare PIN