Colleen A Malloy, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

036102036 Issued in IL

Practice address

250 E Superior St FL 10
Chicago, IL 60611-2914

Phone

(312) 472-3776

Fax

(312) 472-4099

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lurie Children's Medical Group Inc

  dba LCMG Inc

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1518064716
  Medicare reassignment

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1659324317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 45",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "773-880-4142",
            "fax_number": "773-880-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E SUPERIOR ST FL 10",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112914",
            "telephone_number": "312-472-3776",
            "fax_number": "312-472-4099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10400 Haligus Rd",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429553",
            "country_code": "US",
            "telephone_number": "312-227-6010",
            "fax_number": "884-654-0345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11190 Health Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Naples",
            "state": "FL",
            "postal_code": "341105729",
            "country_code": "US",
            "telephone_number": "239-624-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLOY",
        "first_name": "COLLEEN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "FL",
            "license": "ME167883",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036102036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Christine Malloni, LCPC
• Aaron Mallory, LCSW
• Erin Rebecca Mallory, MS D.T.
• Latasha Tene Mallory
• Telice Mallory
• Kelly Malloy
• Phillip J Malloy, PT
• Riley Shannon Malloy, MS
• Jennifer Mally, LCPC
• Eric Christopher Malm, LCSW

• Neonatal-Perinatal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Neonatal-Perinatal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.