Individual
JOSEPH BEN MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 MINNESOTA DR STE 800, EDINA, MN 55435-7915
(612) 595-1100
(612) 294-4903
Mailing address
3600 MINNESOTA DR STE 800, EDINA, MN 55435-7915
(612) 595-1100
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036063108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063108
—
IL
01
—
05032053
BCBS OF IL
IL
Enumeration date
10/06/2006
Last updated
03/10/2025
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