Individual
MICHAEL CRAIG MALLEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3355 RIVERBEND DR STE 200, SPRINGFIELD, OR 97477-8800
(541) 868-9247
(541) 485-0452
Mailing address
3355 RIVERBEND DR, STE 200, SPRINGFIELD, OR 97477-8800
(541) 868-9247
(541) 485-0452
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
M7108
ID
207RN0300X
Nephrology Physician
M7108
ID
207RN0300X
Nephrology Physician
Primary
MD20251
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002160
BLUE SHIELD
ID
05
—
003813700
—
ID
01
—
12252
BLUE CROSS
ID
05
—
150023
—
OR
01
—
390004362
RR MEDICARE
ID
Enumeration date
07/13/2006
Last updated
06/29/2022
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