Provider Demographics
NPI:1033390521
Name:MALEBRANCHE, LIONEL JUNIOR (MD)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:JUNIOR
Last Name:MALEBRANCHE
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 1:112 NE CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1901
Mailing Address - Country:US
Mailing Address - Phone:309-672-4670
Mailing Address - Fax:309-672-4669
Practice Address - Street 1:112 NE CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1901
Practice Address - Country:US
Practice Address - Phone:309-672-4670
Practice Address - Fax:309-672-4669
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009208207R00000X, 207RC0000X
ILC1-0009208207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine