Healthcare Provider Details

I. General information

NPI: 1033101423
Provider Name (Legal Business Name): DENNIS EUGENE MALECKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 W 95TH ST SUITE 6
HICKORY HILLS IL
60457-2700
US

IV. Provider business mailing address

8700 W 95TH ST SUITE 6
HICKORY HILLS IL
60457-2700
US

V. Phone/Fax

Practice location:
  • Phone: 708-430-2400
  • Fax: 708-430-2417
Mailing address:
  • Phone: 708-430-2400
  • Fax: 708-430-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number03652516
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: