Provider Demographics
NPI:1609878495
Name:MALIN, STEPHEN (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:MALIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4678 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4624
Mailing Address - Country:US
Mailing Address - Phone:561-689-1414
Mailing Address - Fax:561-689-1993
Practice Address - Street 1:4678 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4624
Practice Address - Country:US
Practice Address - Phone:561-689-1414
Practice Address - Fax:561-689-1993
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO780213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041082900Medicaid
FL041082900Medicaid
FL87509YMedicare UPIN