Basic Information
| Provider Information | |||||||||
| NPI: | 1982041745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALICAY | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1512 N NAPER BLVD STE 176 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605639369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305264010 | ||||||||
| FaxNumber: | 6305264014 | ||||||||
| Practice Location | |||||||||
| Address1: | 1512 N NAPER BLVD STE 176 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605639369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3065264010 | ||||||||
| FaxNumber: | 6305264014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01076694A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01723975 | 01 | IN | RR MEDICARE | OTHER | 201169110 | 05 | IN | MEDICAID |