1437160876 NPI number — MALCOLM A DEAM MD & ASSOCIATES SC

Table of content: (NPI 1437160876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437160876 NPI number — MALCOLM A DEAM MD & ASSOCIATES SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALCOLM A DEAM MD & ASSOCIATES SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437160876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 OAKMONT LN
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-789-2550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ERIE CT
Provider Second Line Business Practice Location Address:
SUITE L500
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302-2566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-383-6200
Provider Business Practice Location Address Fax Number:
708-383-1793
Provider Enumeration Date:
08/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEAM
Authorized Official First Name:
MALCOLM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-383-6200

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2160743632 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CB4052 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".