Individual
JASMINE MATHEW MALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 N WALL ST, SUITE 304, KANKAKEE, IL 60901-2940
(815) 929-1388
(815) 935-7062
Mailing address
PO BOX 13749, PHILADELPHIA, PA 19101-3749
(855) 447-2240
(302) 733-0854
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01074614A
IN
207L00000X
Anesthesiology Physician
Primary
036101753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101753
—
IL
01
—
P01059367
RAILROAD MEDICARE
IL
Enumeration date
06/08/2006
Last updated
03/12/2018
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