| Doctor Name: | DR. THOMAS A. MALLISEE |
| NPI Number: | 1639167042 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 32854 |
| Business Practice Address: | 1111 6th Ave Des Moines, IA - 503142613 |
| Business Phone Number: | 5156432667 |
| Business Fax Number: | 5156432978 |
| Mailing Address: | 1111 6th Ave, DES MOINES |
| State: | IA |
| Postal Code: | 503142613 |
| Phone Number: | 5156432667 |
| Fax Number: | 5156432978 |
| NPI Enumeration Date: | 10/10/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 32854 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |