Provider Demographics
NPI:1174785513
Name:MALKA, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MALKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 20TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1832
Mailing Address - Country:US
Mailing Address - Phone:865-331-4321
Mailing Address - Fax:865-331-4320
Practice Address - Street 1:501 20TH ST STE 503
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1832
Practice Address - Country:US
Practice Address - Phone:865-331-4321
Practice Address - Fax:865-331-4320
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35C.0015112084N0400X
TNMD535002084N0400X
WAMD615445862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019284Medicaid
TN103I137256Medicare PIN