Individual
MICHAEL J MALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4651 SHERIDAN ST STE 350, HOLLYWOOD, FL 33021-3425
(954) 276-8559
(954) 966-9762
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS8804
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274719700
—
FL
Enumeration date
07/27/2006
Last updated
03/17/2021
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