Provider Demographics
NPI:1326196411
Name:MALICAY, MANUEL ALABAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ALABAN
Last Name:MALICAY
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 1:402 W BOUGHTON RD
Mailing Address - Street 2:F
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1872
Mailing Address - Country:US
Mailing Address - Phone:630-759-3782
Mailing Address - Fax:630-759-1276
Practice Address - Street 1:402 W BOUGHTON RD
Practice Address - Street 2:F
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1872
Practice Address - Country:US
Practice Address - Phone:630-759-3782
Practice Address - Fax:630-759-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-051711Medicaid
IL247500Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL247500Medicare ID - Type UnspecifiedMEDICARE
IL036-051711Medicaid