Provider Demographics
NPI:1437160876
Name:MALCOLM A DEAM MD & ASSOCIATES SC
Entity Type:Organization
Organization Name:MALCOLM A DEAM MD & ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-383-6200
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:SUITE L500
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2566
Practice Address - Country:US
Practice Address - Phone:708-383-6200
Practice Address - Fax:708-383-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2160743632OtherBCBS PROVIDER ID
ILCB4052OtherRAILROAD MEDICARE
IL=========OtherOWCP PROVIDER ID
ILCB4052OtherRAILROAD MEDICARE