Provider Demographics
NPI:1134136336
Name:MALALIS, JANE R (MD)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:R
Last Name:MALALIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 SARANAC LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-205-1780
Mailing Address - Fax:
Practice Address - Street 1:1401 DUGDALE CIRCLE
Practice Address - Street 2:ANN KICEY CENTER
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-249-0600
Practice Address - Fax:847-249-9701
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36058419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14347Medicare UPIN
ILL61958Medicare ID - Type Unspecified