Basic Information
| Provider Information | |||||||||
| NPI: | 1063641579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROUT | ||||||||
| FirstName: | MALACHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLARK | ||||||||
| OtherFirstName: | MALACHIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 426 LIBERTY LN | ||||||||
| Address2: | |||||||||
| City: | HORACE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580474523 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012348800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5984 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 5984 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 12886 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.