Individual
PAUL MALLAMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
52526 FORD LN, CHESTERFIELD, MI 48047-3514
(586) 598-0455
Mailing address
52526 FORD LN, CHESTERFIELD, MI 48047-3514
(586) 598-0455
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
5901001813
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4253362
—
MI
01
—
480030776
RAILROAD MEDICARE
MI
Enumeration date
03/20/2007
Last updated
07/28/2014
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