Provider Demographics
NPI:1144221961
Name:MALAKER, CLAYTON R (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:R
Last Name:MALAKER
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 1:824 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-2252
Mailing Address - Country:US
Mailing Address - Phone:815-544-3481
Mailing Address - Fax:
Practice Address - Street 1:824 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-2252
Practice Address - Country:US
Practice Address - Phone:815-544-3481
Practice Address - Fax:815-544-3700
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075458Medicaid
ILE18666Medicare UPIN