Provider Demographics
NPI:1760590095
Name:MALENCH & MALENCH MDS
Entity Type:Organization
Organization Name:MALENCH & MALENCH MDS
Other - Org Name:ANTHONY E MALENCH MD PETER B MALENCH MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALENCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-288-7244
Mailing Address - Street 1:10 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-288-7244
Mailing Address - Fax:618-288-1980
Practice Address - Street 1:10 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-7244
Practice Address - Fax:618-288-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAM3064312Medicare ID - Type UnspecifiedANTHONY MALENCH
ILF95463Medicare UPIN
ILBM3074654Medicare ID - Type UnspecifiedPETER MALENCH
ILC45814Medicare UPIN