Provider Demographics
NPI:1598750549
Name:DEAM, MALCOLM A (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:A
Last Name:DEAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:708-763-6478
Practice Address - Fax:708-383-1793
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036043300207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2160743632OtherBCBS PROVIDER ID
IL110044982OtherRAILROAD MEDICARE
IL036043300Medicaid
IL363150672OtherOWCP PROVIDER ID
IL110044982OtherRAILROAD MEDICARE
ILC42117Medicare UPIN