Healthcare Provider Details

I. General information

NPI: 1104858661
Provider Name (Legal Business Name): MALKA BELINDA RADIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SHERMER RD
NORTHBROOK IL
60062-4579
US

IV. Provider business mailing address

1310 SHERMER RD
NORTHBROOK IL
60062-4579
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-3434
  • Fax: 224-235-4195
Mailing address:
  • Phone: 847-498-3434
  • Fax: 224-235-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036078148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: