Provider Demographics
NPI:1194035360
Name:MICHEL H. MALEK, MD SC
Entity Type:Organization
Organization Name:MICHEL H. MALEK, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-936-3204
Mailing Address - Street 1:555 W COURT ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3664
Mailing Address - Country:US
Mailing Address - Phone:815-936-3204
Mailing Address - Fax:
Practice Address - Street 1:555 W COURT ST
Practice Address - Street 2:SUITE 412
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3664
Practice Address - Country:US
Practice Address - Phone:815-936-3204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079256207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205535Medicare PIN
ILF26845Medicare UPIN