1255499653 NPI number — DR. MICHAEL C MALINICS D.O.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255499653 NPI number — DR. MICHAEL C MALINICS D.O.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MALINICS

Provider First Name:

MICHAEL

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.O.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1255499653

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/22/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1320 W MAIN ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WATERBURY

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06708-3119

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-709-7300

Provider Business Mailing Address Fax Number:

203-709-4501

Provider First Line Business Practice Location Address:

1320 W MAIN ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WATERBURY

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06708-3119

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

203-709-7300

Provider Business Practice Location Address Fax Number:

203-709-4501

Provider Enumeration Date:

12/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  000239 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 001002394 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 4250662 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 020239-7359 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 2V9983 . This is a "HEALTHNET/COMMERCIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P00453279 . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 21-50233 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 21-50233 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 1086984 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 1255499653 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 040000239CT08 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 415474 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P3837931 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".