Healthcare Provider Details

I. General information

NPI: 1225083983
Provider Name (Legal Business Name): MALHOTRA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16750 80TH AVE SUITE E
TINLEY PARK IL
60477-3173
US

IV. Provider business mailing address

PO BOX 970
MATTESON IL
60443-0970
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-9000
  • Fax: 708-633-9016
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-052517
License Number StateIL

VIII. Authorized Official

Name: SHASHI K MALHOTRA
Title or Position: OWNER
Credential: M.D.
Phone: 708-633-9000