Healthcare Provider Details

I. General information

NPI: 1952312266
Provider Name (Legal Business Name): PHILIP MALINOSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 OLD JACKSONVILLE RD SUITE 110
SPRINGFIELD IL
62704-7400
US

IV. Provider business mailing address

PO BOX 4488
SPRINGFIELD IL
62708-4488
US

V. Phone/Fax

Practice location:
  • Phone: 217-862-0062
  • Fax: 217-862-0064
Mailing address:
  • Phone: 217-757-7491
  • Fax: 217-757-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: