=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649583485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALINE MALEBRANCHE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2010
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 E WAR MEMORIAL DRIVE
-----------------------------------------------------
City | PEORIA HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-220-6432
-----------------------------------------------------
Fax | 630-734-4715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 W PARK ST
-----------------------------------------------------
City | URBANA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61801-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-383-3311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 036136910
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------