Provider Demographics
NPI:1316100860
Name:MALINOWSKI, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MALINOWSKI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:VASCULAR SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-9160
Mailing Address - Fax:414-805-9170
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:VASCULAR SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9160
Practice Address - Fax:414-805-9170
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2013-10-03
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Provider Licenses
StateLicense IDTaxonomies
IL125051307208600000X, 2086S0129X
IL036.1269012086S0129X
WI607942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316100860Medicaid