Provider Demographics
NPI:1619071966
Name:HAJAT, MALA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MALA
Middle Name:
Last Name:HAJAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:P. MALA
Other - Middle Name:
Other - Last Name:HAJAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:28 DEER PATH TRL
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6324
Mailing Address - Country:US
Mailing Address - Phone:630-624-7476
Mailing Address - Fax:
Practice Address - Street 1:10723 WINTERSET DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1106
Practice Address - Country:US
Practice Address - Phone:708-364-7098
Practice Address - Fax:708-364-7310
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336026193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061625Medicaid
ILIL6473Medicare PIN