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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