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Organization
CLAYTON R. MALAKER, M.D., S.C.
Active
Organization
CLAYTON R. MALAKER, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLAYTON R. MALAKER M.D. (PRESIDENT)
(815) 544-3481
Entity
Organization
Contact information
Practice address
824 VAN BUREN ST, BELVIDERE, IL 61008-2252
(815) 544-3481
Mailing address
824 VAN BUREN ST, BELVIDERE, IL 61008-2252
(815) 544-3481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-075458
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000400014
BLUE CROSS/ BLUE SHIELD
IL
01
—
036-075458
ILLINOIS LICENSE
IL
05
—
036075458
—
IL
Enumeration date
12/16/2009
Last updated
03/16/2010
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