Dana R Malkovich, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23590 Issued in MN

Practice address

417 Skyline Blvd
Cloquet, MN 55720-1164

Phone

(218) 879-1271

Fax

(218) 879-8904

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1811079155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201164",
            "telephone_number": "218-879-1271",
            "fax_number": "218-879-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201164",
            "telephone_number": "218-879-1271",
            "fax_number": "218-879-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALKOVICH",
        "first_name": "DANA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "23590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0102326",
            "state": "FM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294395600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUES & FIRST PLAN",
            "identifier": "52586MA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Scottt Ludwig, DDS
• David D Luehr, M.D.
• Melinda Macdonald
• Nicole Madsen, PHARMD
• Magnolia Care LLC
• Jaime-Lynn Mallory Lagraves, MSED, LPCC
• Mary Kay Marciniak, RN,CDE
• York Marlowe, LPCC
• Jennifer Sue Martineau
• Jean Lynn Maslowski, RD LD CDE

• Family Medicine Physician in Cloquet, MN
• Providers in Cloquet, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.