Provider Demographics
NPI:1033101423
Name:MALECKI, DENNIS EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EUGENE
Last Name:MALECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 W 95TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2700
Mailing Address - Country:US
Mailing Address - Phone:708-430-2400
Mailing Address - Fax:708-430-2417
Practice Address - Street 1:8700 W 95TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2700
Practice Address - Country:US
Practice Address - Phone:708-430-2400
Practice Address - Fax:708-430-2417
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03652516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363137473OtherTAX ID
IL036052516Medicaid
IL080037003OtherPALMETTO GBA RAIL ROAD MEDICARE
IL363137473OtherTAX ID
IL080037003OtherPALMETTO GBA RAIL ROAD MEDICARE