Healthcare Provider Details

I. General information

NPI: 1790757797
Provider Name (Legal Business Name): BALAJI MALUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE INGALLS DR INGALLS MEMORIAL HOSPITAL
HARVEY IL
60426
US

IV. Provider business mailing address

222 E DUNDEE RD HARVEY ANESTHESIOLOGISTS SC
WHEELING IL
60090
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-2300
  • Fax:
Mailing address:
  • Phone: 847-520-0235
  • Fax: 847-520-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: