Organization
ANTELOPE MEDICAL CONSULTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA ANNE MALODY M.D. (OWNER)
(307) 682-7661
Entity
Organization
Contact information
Practice address
430 S MEDICAL ARTS CT, GILLETTE, WY 82716-3364
(307) 682-7661
(307) 682-5074
Mailing address
430 S MEDICAL ARTS CT, GILLETTE, WY 82716-3364
(307) 682-7661
(307) 682-5074
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5806A
WY
207RC0000X
Cardiovascular Disease Physician
Primary
5853A
WY
363LF0000X
Family Nurse Practitioner
18882.269
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00783001
BLUE CROSS CLINIC NUMBER
WY
05
—
7088727
—
WA
Enumeration date
12/08/2006
Last updated
09/11/2025
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