Individual
THOMAS MALOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
285 W 12TH ST, STE 112, PERU, IN 46970-1653
(765) 475-2388
Mailing address
285 W 12TH ST, STE. 103, PERU, IN 46970-1653
(765) 475-2316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000716A
IN
Other
Enumeration date
04/19/2006
Last updated
03/27/2012
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