Provider Demographics
NPI:1437379724
Name:MANUEL A.MALICAY MD SC
Entity Type:Organization
Organization Name:MANUEL A.MALICAY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ALABAN
Authorized Official - Last Name:MALICAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-354-2235
Mailing Address - Street 1:430 N. SHERWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:LA GRAGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526
Mailing Address - Country:US
Mailing Address - Phone:708-354-2235
Mailing Address - Fax:708-354-2235
Practice Address - Street 1:430 N. SHERWOOD ROAD
Practice Address - Street 2:
Practice Address - City:LA GRAGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526
Practice Address - Country:US
Practice Address - Phone:708-354-2235
Practice Address - Fax:708-354-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2475000Medicare ID - Type Unspecified