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NPI Code Detail

MEDICARE: DR. NICOLE AMALIA MALEK D.O.

MEDICARE: DR. NICOLE AMALIA MALEK D.O.
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
1207Q00000XFamily Medicine Physician036123281IL

General Provider Information

NPI Number : 1235385220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE AMALIA MALEK D.O.
Provider Business Mailing Address
First Line : 3048 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3720
Country : US
Telephone Number : 773-961-3200
Fax Number :
Provider Business Practice Location Address
First Line : 3048 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3720
Country : US
Telephone Number : 773-961-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2008
Last Update Date : 11/10/2021

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