Provider Demographics
NPI:1043574338
Name:MALHOTRA, NEIL
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5340
Mailing Address - Country:US
Mailing Address - Phone:708-981-3901
Mailing Address - Fax:708-981-3912
Practice Address - Street 1:16045 108TH AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5345
Practice Address - Country:US
Practice Address - Phone:708-981-3901
Practice Address - Fax:708-981-3912
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140713207L00000X
IL036.140713390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program