Provider Demographics
NPI:1043327505
Name:MALEN, PAUL GORDON (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GORDON
Last Name:MALEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:2323 S 109TH ST
Practice Address - Street 2:#220
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-541-5222
Practice Address - Fax:414-541-4959
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI25843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30029200Medicaid
AM8356885OtherDEA NUMBER
B54776Medicare UPIN
80-109Medicare ID - Type UnspecifiedMEDICARE PROVIDER