Provider Demographics
NPI:1891781951
Name:MALCHAREK, PAUL G (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:MALCHAREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5401
Mailing Address - Country:US
Mailing Address - Phone:618-344-3046
Mailing Address - Fax:618-344-5284
Practice Address - Street 1:2401 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5401
Practice Address - Country:US
Practice Address - Phone:618-344-3046
Practice Address - Fax:618-344-5284
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093757Medicaid
IL036093757Medicaid
ILIL2868135Medicare PIN