Mallea, Michael Craig
Mallea, Michael Craig is an individual health care provider with primary practice located at 3355 Riverbend Dr Ste 200 , Springfield OR 97477-8800. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is his primary health care specialty. Mallea, Michael Craig can be contacted via phone (541) 868-9247.Contact Information
Primary practice address
3355 Riverbend Dr Ste 200
Springfield OR 97477-8800
Phone: (541) 868-9247
Fax: (541) 485-0452
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | M7108 | Idaho |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | M7108 | Idaho |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | MD20251 | Oregon |
Profile Details
| NPI number | 1043235377 |
|---|---|
| LBN Legal business name | Mallea, Michael Craig |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 13th, 2006 |
| Last updated | Jun 29th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043235377 | NPPES |
| Idaho | Other | 12252 | BLUE CROSS |
| Idaho | MEDICAID | 150023 | BLUE CROSS |
| Idaho | Other | 390004362 | BLUE CROSS |
| Idaho | Other | 000010002160 | BLUE CROSS |
| Idaho | MEDICAID | 003813700 | BLUE CROSS |
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