Provider Demographics
NPI:1841299690
Name:MALECHA, MONIKA A (MD)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:A
Last Name:MALECHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:BEDNARZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1902
Mailing Address - Country:US
Mailing Address - Phone:503-221-0161
Mailing Address - Fax:
Practice Address - Street 1:15950 SW MILLIKAN WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-5170
Practice Address - Country:US
Practice Address - Phone:503-646-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30575207W00000X
MO2004004163207W00000X
ORMD27068207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR140611Medicare PIN