| Doctor Name: | DR. CHARLES MILES MALISKA |
| NPI Number: | 1053467894 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A99319 |
| Business Practice Address: | 1919 S Wheeling Ave Ste 600 Bernsen Building Tulsa, OK - 741045635 |
| Business Phone Number: | 9186347500 |
| Business Fax Number: | |
| Mailing Address: | 1802 E 19th St, Kravis Building, St. John Medical Center TULSA |
| State: | OK |
| Postal Code: | 741045403 |
| Phone Number: | 9186347543 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 12/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A99319 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |