Healthcare Provider Details

I. General information

NPI: 1679196737
Provider Name (Legal Business Name): MALINA PATEL BHALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6827 KINGERY HWY
WILLOWBROOK IL
60527-5154
US

IV. Provider business mailing address

1710 MIDWEST CLUB PKWY
OAK BROOK IL
60523-2588
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-1212
  • Fax:
Mailing address:
  • Phone: 214-418-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number125.076757
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.076757
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: