Basic Information
| Provider Information | |||||||||
| NPI: | 1760590095 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MALENCH & MALENCH MDS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANTHONY E MALENCH MD PETER B MALENCH MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 PROFESSIONAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182887244 | ||||||||
| FaxNumber: | 6182881980 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 PROFESSIONAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182887244 | ||||||||
| FaxNumber: | 6182881980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MALENCH | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6182887244 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.