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General NPI Number Information
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NPI Number | 1326070210
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Entity Type | Individual
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Provider Name | TIMOTHY MALISCH MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 800 BIESTERFIELD RD EBERLE PLAZA, SUITE 610
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3361
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Country | US
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Telephone | 847-981-3672
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Fax | 847-981-3626
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Provider Business Mailing Address
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Address Line | 800 BIESTERFIELD RD EBERLE PLAZA, SUITE 610
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3361
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Country | US
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Telephone | 847-981-3672
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Fax | 847-981-3626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 036-096145
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-096145
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License Number State | IL
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