Provider Demographics
NPI:1407603517
Name:ABDELMALAK, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ABDELMALAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 N. MAIN ST., UNIT 204
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103
Mailing Address - Country:US
Mailing Address - Phone:416-312-5616
Mailing Address - Fax:
Practice Address - Street 1:1221 E. STATE ST.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:815-972-1037
Practice Address - Fax:815-972-1086
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program