Provider Demographics
NPI:1588776926
Name:MALICDEM, MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:MALICDEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BROOKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-6760
Mailing Address - Country:US
Mailing Address - Phone:810-513-8063
Mailing Address - Fax:
Practice Address - Street 1:27014 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4045
Practice Address - Country:US
Practice Address - Phone:440-438-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine