Provider Demographics
NPI:1891807871
Name:AKHAL, MALEK (MD)
Entity Type:Individual
Prefix:
First Name:MALEK
Middle Name:
Last Name:AKHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MALEK
Other - Middle Name:
Other - Last Name:AL-AKHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1353
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399980OtherMEDICARE PTAN
IL036121167Medicaid
R131346Medicare ID - Type Unspecified
911019392OtherCOMMERCIAL
WA8426116Medicaid
R131346Medicare ID - Type Unspecified
IL399980OtherMEDICARE PTAN
911019392OtherCOMMERCIAL