Provider Demographics
NPI:1568525277
Name:MALKERNEKER, USHA D (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:D
Last Name:MALKERNEKER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17100 DIXIE HWY STE D
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1485
Mailing Address - Country:US
Mailing Address - Phone:708-335-1155
Mailing Address - Fax:708-335-1171
Practice Address - Street 1:17100 DIXIE HWY STE D
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1485
Practice Address - Country:US
Practice Address - Phone:708-335-1155
Practice Address - Fax:708-335-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.0573052084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36369473501Medicaid