Provider Demographics
NPI:1396853610
Name:MALFESE, DAVID C (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MALFESE
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 1:6461 W WARNER AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-6206
Mailing Address - Country:US
Mailing Address - Phone:720-737-6497
Mailing Address - Fax:
Practice Address - Street 1:10 W MARKET ST STE 2900
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2964
Practice Address - Country:US
Practice Address - Phone:866-434-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73718207Q00000X
WI41373207Q00000X
CODR0053194207Q00000X
IL036162886207Q00000X
AR16898207Q00000X
IA51764207Q00000X
TXU6524207Q00000X
OK41786207Q00000X
MO2023036758207Q00000X
IN01091404A207Q00000X
MS31938207Q00000X
OH35149587207Q00000X
CAC192291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34091900Medicaid
WI095472200Medicare ID - Type Unspecified
H37738Medicare UPIN