Individual
DR. MICHAEL KEITH MALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 S. 9TH STREET, 1ST FLOOR, PHILADELPHIA, PA 19107-4408
(215) 955-1200
(215) 923-6808
Mailing address
25 S. 9TH STREET, 1ST FLOOR, PHILADELPHIA, PA 19107-4408
(215) 955-1200
(215) 923-6808
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD436445
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0272132
—
NJ
05
—
1023098190002
—
PA
01
—
MD436445
PA LICENSE
PA
Enumeration date
03/30/2007
Last updated
09/26/2014
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