Individual
STEPHEN M MALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-1111
(305) 585-6960
Mailing address
1500 NW 12TH AVE, JMT-EAST 1004, MIAMI, FL 33136-1028
(305) 585-6779
(305) 585-6960
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME12372
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0511757-00
—
FL
Enumeration date
07/10/2006
Last updated
05/08/2013
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