Basic Information
| Provider Information | |||||||||
| NPI: | 1255499653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALINICS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 421718 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294424203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436528226 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4040 HIGHWAY 17 UNIT 202 | ||||||||
| Address2: | |||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295765098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432353131 | ||||||||
| FaxNumber: | 2037095545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 03/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 000239 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 001002394 | 05 | CT | MEDICAID | 020239-7359 | 01 | CT | CONNECTICARE | OTHER | 040000239CT08 | 01 | CT | ANTHEM BCBS CT | OTHER | 1255499653 | 05 | CT | MEDICAID | 415474 | 01 | CT | WELLCARE | OTHER | P3837931 | 01 | CT | OXFORD | OTHER | 4250662 | 01 | CT | AETNA | OTHER | 1086984 | 01 | CT | USA | OTHER | 21-50233 | 01 | CT | UHC | OTHER | P00453279 | 01 | CT | RR MEDICARE | OTHER | 21-50233 | 01 | CT | AMERICHOICE | OTHER | 2V9983 | 01 | CT | HEALTHNET/COMMERCIAL | OTHER |