Provider Demographics
NPI:1457924417
Name:MALAS, MOKHTAR (MD)
Entity type:Individual
Prefix:
First Name:MOKHTAR
Middle Name:
Last Name:MALAS
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 1:2850 W 95TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2741
Mailing Address - Country:US
Mailing Address - Phone:708-636-9205
Mailing Address - Fax:708-422-5505
Practice Address - Street 1:2850 W 95TH ST STE 301
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2741
Practice Address - Country:US
Practice Address - Phone:708-636-9205
Practice Address - Fax:708-422-5505
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036176183207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program