Raquel Malabanan, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036091422 Issued in IL

Practice address

1200 W State St
Rockford, IL 61102-2112

Phone

(815) 490-1600

NPI assigned

Nov 23, 2005

Last updated

Jan 25, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264377600000",
    "number": "1326021361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2961 HUBBARD TRL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145803",
            "telephone_number": "815-636-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALABANAN",
        "first_name": "RAQUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-23",
        "last_updated": "2010-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036091422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091422",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Georgina Maier
• Yazaria Major
• Olabisi Makanjuola, MD
• Jude Buenz Makulec, MPT, RPT
• Kamya Prafulbhai Makwana, BDS, PGDHHM, DDS
• Justyna Malanowicz
• Kimberly Malavolti, PA
• Jason H Malenfant, M.D.
• Emad Malick, PHARMD
• Malik Eye Institute LLC (Eye Specialist of Rockford)

• Pediatrics Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.