Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 036130364 | IL |
NPI | 1134361454 |
---|---|
Provider Name | Lindsey Terrell Malone |
First Address | Willowbrook, IL 60527-7601 |
Second Address | Willowbrook, IL 60527-7600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 09/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
596640002 | MEDICARE PTAN (01) | IL |