Healthcare Provider Details

I. General information

NPI: 1679566707
Provider Name (Legal Business Name): ABDUL MALHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W NORTHWEST HWY
PALATINE IL
60067-2414
US

IV. Provider business mailing address

385 W NORTHWEST HWY
PALATINE IL
60067-2414
US

V. Phone/Fax

Practice location:
  • Phone: 847-359-9800
  • Fax: 847-359-9899
Mailing address:
  • Phone: 847-359-9800
  • Fax: 847-359-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093066
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: