Provider Demographics
NPI:1073609491
Name:MALECKI, ELISE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:MALECKI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S WOOD STREET
Mailing Address - Street 2:(MC 716) UNIVERSITY OF ILLINOIS AT CHICAGO
Mailing Address - City:CHIGAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-0001
Mailing Address - Country:US
Mailing Address - Phone:312-996-0414
Mailing Address - Fax:
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51466-20207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology