MEDICARE: DR. CLAYTON R. MALAKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036075458	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144221961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON R. MALAKER M.D.

Provider Business Mailing Address
First Line	:	824 VAN BUREN ST
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-2252
Country	:	US
Telephone Number	:	815-544-3481
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 VAN BUREN ST
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-2252
Country	:	US
Telephone Number	:	815-544-3481
Fax Number	:	815-544-3700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/16/2010

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