Active NPI
Jane R Malalis, MD
- Family Medicine Physician
- Waukegan, IL
National Provider Identifier
1134136336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36058419
- Practice address
- 1401 Dugdale Circle
Ann Kicey Center
Waukegan, IL 60085 - Phone
- (847) 249-0600
- Fax
- (847) 249-9701
- NPI assigned
- Aug 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36058419 | IL | Primary |
Addresses
Primary practice location
1401 Dugdale Circle
Ann Kicey Center
Waukegan, IL 60085
Mailing address
2460 Saranac LN
Glenview, IL 60025
Phone (847) 205-1780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36058419 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1134136336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2460 SARANAC LN",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "60025",
"telephone_number": "847-205-1780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 DUGDALE CIRCLE",
"address_2": "ANN KICEY CENTER",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "60085",
"telephone_number": "847-249-0600",
"fax_number": "847-249-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALALIS",
"first_name": "JANE",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "36058419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.