Healthcare Provider Details

I. General information

NPI: 1326070210
Provider Name (Legal Business Name): TIMOTHY MALISCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD EBERLE PLAZA, SUITE 610
ELK GROVE VILLAGE IL
60007-3361
US

IV. Provider business mailing address

800 BIESTERFIELD RD EBERLE PLAZA, SUITE 610
ELK GROVE VILLAGE IL
60007-3361
US

V. Phone/Fax

Practice location:
  • Phone: 847-981-3672
  • Fax: 847-981-3626
Mailing address:
  • Phone: 847-981-3672
  • Fax: 847-981-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-096145
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036-096145
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: