Basic Information
| Provider Information | |||||||||
| NPI: | 1194035360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHEL H. MALEK, MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 W COURT ST | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609013664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159363204 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 W COURT ST | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609013664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159363204 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2010 | ||||||||
| LastUpdateDate: | 10/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | MALEK | ||||||||
| AuthorizedOfficialFirstName: | MICHEL | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 8159363204 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 036079256 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.