Basic Information
| Provider Information | |||||||||
| NPI: | 1841482395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IZOLD A MALAMENT MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36001 EUCLID AVE STE B12 | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144305724 | ||||||||
| FaxNumber: | 6144305742 | ||||||||
| Practice Location | |||||||||
| Address1: | 36001 EUCLID AVE STE B12 | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409751190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2007 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | MALAMENT | ||||||||
| AuthorizedOfficialFirstName: | IZOLD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4409751190 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.