Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 23884 | MN |
NPI | 1275582348 |
---|---|
Provider Name | John William Malo |
First Address | Minneapolis, MN 55407-1544 |
Second Address | Minneapolis, MN 55407-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 24/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0255502 | PREFERRED ONE (01) | MN |
64G46MA | BLUE CROSS (01) | MN |
7425178 | MEDICA (01) | MN |
768243 | AMERICAS PPO (01) | MN |
HP13904 | HEALTH PARTNERS (01) | MN |