Healthcare Provider Details

I. General information

NPI: 1174665772
Provider Name (Legal Business Name): ANNA MARIE FRUEH MALEK DN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5248 N MELVINA AVE
CHICAGO IL
60630-1037
US

IV. Provider business mailing address

5248 N MELVINA AVE
CHICAGO IL
60630-1037
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-1419
  • Fax: 773-631-3110
Mailing address:
  • Phone: 773-631-1419
  • Fax: 773-631-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number181-000223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: