Basic Information
| Provider Information | |||||||||
| NPI: | 1912208554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALOUF | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2295 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288022295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283985244 | ||||||||
| FaxNumber: | 8283603080 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 S HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832865000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083907843 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APRN-1504 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 598527-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.