| Clayton R. Malaker, M.d., S.c. | |
|
824 Van Buren St Belvidere IL 61008-2252 | |
| (815) 544-3481 | |
| Not Available |
| Full Name | Clayton R. Malaker, M.d., S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 824 Van Buren St, Belvidere, Illinois |
| Authorized Official Name and Position | Clayton R. Malaker (PRESIDENT) |
| Authorized Official Contact | 8155443481 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clayton R. Malaker, M.d., S.c. 824 Van Buren St Belvidere IL 61008-2252 Ph: (815) 544-3481 | Clayton R. Malaker, M.d., S.c. 824 Van Buren St Belvidere IL 61008-2252 Ph: (815) 544-3481 |
| NPI Number | 1144559485 |
|---|---|
| Provider Enumeration Date | 12/16/2009 |
| Last Update Date | 03/16/2010 |
| Medicare PECOS PAC ID | 4486796604 |
|---|---|
| Medicare Enrollment ID | O20100126000285 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144559485 | NPI | - | NPPES |
| 036-075458 | Other | IL | ILLINOIS LICENSE |
| 0000400014 | Other | IL | BLUE CROSS/ BLUE SHIELD |
| 036075458 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-075458 (Illinois) | Primary |
| Provider Name | Clayton Russell Malaker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144221961 PECOS PAC ID: 0941342166 Enrollment ID: I20100126000281 |
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