Provider Demographics
NPI:1134361454
Name:MALONE, LINDSEY TERRELL (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:TERRELL
Last Name:MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PLAINFIELD RD STE C
Mailing Address - Street 2:# 3
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7601
Mailing Address - Country:US
Mailing Address - Phone:630-654-2229
Mailing Address - Fax:630-655-3270
Practice Address - Street 1:545 PLAINFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7600
Practice Address - Country:US
Practice Address - Phone:630-654-2229
Practice Address - Fax:630-655-3270
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130364207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL596640002OtherMEDICARE PTAN