Provider Demographics
NPI:1386757581
Name:MALKO, MAREK (MD)
Entity type:Individual
Prefix:DR
First Name:MAREK
Middle Name:
Last Name:MALKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE LL001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-202-9622
Mailing Address - Fax:773-993-0883
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE LL001
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-202-9622
Practice Address - Fax:773-993-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106441Medicaid
IL036106441Medicaid
ILL92617Medicare PIN