MEDICARE: CLAYTON R. MALAKER, M.D., S.C.

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	036-075458	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-075458	OTHER	IL	ILLINOIS LICENSE
2	0000400014	OTHER	IL	BLUE CROSS/ BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144559485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAYTON R. MALAKER, M.D., S.C.

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLAYTON R. MALAKER
Credential	:	M.D.
Telephone Number	:	815-544-3481

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	03/16/2010

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