MICHAEL CRAIG MALLEA M.D. NPI 1043235377

NPI Information

NPI: 1043235377
Provider Name: MICHAEL CRAIG MALLEA, M.D.
Classification: Internal Medicine - 207RN0300X
Entity Type: Individual

Specialization: Nephrology

PECOS Registration: Yes

Address:
4620 ENTERPRISE WAY STE 101
CALDWELL, ID
ZIP 83605
Phone: (208) 846-8335
Get Directions

Michael Craig Mallea, M.D. is a nephrology internal medicine in Caldwell, ID. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. Michael Craig Mallea, M.D. NPI is 1043235377. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4620 ENTERPRISE WAY STE 101
CALDWELL, ID
ZIP 83605
Phone: (208) 846-8335
Fax: (208) 846-8336

The NPI 1043235377 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/13/2006 and was last updated on 11/26/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		M7108	IDAHO	No
2	207RN0300X	Internal Medicine	Nephrology	M7108	IDAHO	No
3	207RN0300X	Internal Medicine	Nephrology	MD20251	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000010002160	OTHER	IDAHO	BLUE SHIELD
2	12252	OTHER	IDAHO	BLUE CROSS
3	390004362	OTHER	IDAHO	RR MEDICARE
4	003813700	MEDICAID	IDAHO
5	150023	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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