Provider Demographics
NPI:1447297817
Name:MALALIS, LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:MALALIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 JORIE BLVD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2213
Mailing Address - Country:US
Mailing Address - Phone:630-954-6700
Mailing Address - Fax:630-954-1555
Practice Address - Street 1:900 JORIE BLVD
Practice Address - Street 2:SUITE 186
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2213
Practice Address - Country:US
Practice Address - Phone:630-954-6700
Practice Address - Fax:630-954-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0583642080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-058364Medicaid
ILP05093Medicare PIN
ILC40852Medicare UPIN