MALIK T BANDEALY (NPI# 1568453298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568453298 |
| Entity Type | Individual |
| Full Name | MALIK T BANDEALY |
| Credential | MD |
| Practice Address |
10400 75th St Kenosha WI 53142-7884 |
| Mailing Address |
3003 W Good Hope Rd Milwaukee WI 53209-2042 |
| Practice Telephone | 2629429644 |
| Mailing Telephone | 4143523100 |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2010-05-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
38678 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32360000 | 05 |
| Street Address |
10400 75TH ST |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-7884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477546737 | Mea-aea Kenosha Sc | Family Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2005-08-23 |
| 1548877707 | Megan Labine | Dietitian, Registered | 10400 75th St, Kenosha, WI 53142-7884 | 2020-09-30 |
| 1730796574 | Saralyn Paredes | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-7884 | 2020-09-25 |
| 1518586965 | Ariel Adelsen | Registered Nurse | 10400 75th St, Kenosha, WI 53142-7884 | 2020-04-15 |
| 1134757073 | Amber Jirschele | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-8323 | 2020-03-27 |
| 1912539974 | Kristina A Roscizewski | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-7884 | 2020-02-07 |
| 1386274413 | Ethan Nathaniel Mcfaddin | Pharmacist | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
| 1972133031 | Patricia Grzyb | Physician Assistant | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
| 1144873654 | Lauren Cornejo | Occupational Therapist | 10400 75th St, Kenosha, WI 53142-8323 | 2019-07-23 |
| 1245710771 | Brenda Joyce Woodhull | Registered Nurse | 10400 75th St, Kenosha, WI 53142-7884 | 2018-08-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649716358 | Fox Valley Hematology & Oncology, S.c. | Internal Medicine | 1716 Lawrence Dr, De Pere, WI 54115-9108 | 2017-01-19 |
| 1629416409 | Christopher Robert D'angelo | Internal Medicine | 958 Basswood Ave, Verona, WI 53593-8220 | 2013-06-13 |
| 1811250426 | Michael Bade Wheeler | Internal Medicine | 28391 Essential Road, Merton, WI 53056-0012 | 2012-06-19 |
| 1366732752 | Ezzideen Barjes Alrawi | Internal Medicine | 111 Ann St, Waukesha, WI 53188-2263 | 2011-04-19 |
| 1063730042 | Bradley C Heraly | Internal Medicine | 1726 Shawano Avenue, Green Bay Oncology, Green Bay, WI 54303 | 2010-05-14 |
| 1528276417 | Kelly Jo Cooke | Internal Medicine | 721 American Ave Ste 508, Prohealth Care Medical Associates Inc., Waukesha, WI 53188-5071 | 2007-05-21 |
| 1205044773 | Derek Steven Serna | Internal Medicine | 1683 Whistling Hill Cir, Hartland, WI 53029 | 2007-05-18 |
| 1770706624 | Fox Valley Hematology & Oncology, S.c. | Internal Medicine | N3063 Cty Qq, Waupaca, WI 54981-9796 | 2007-04-10 |
| 1003039959 | Fox Valley Hematology & Oncology, S.c. | Internal Medicine | 1370 N Shawano St E, New London, WI 54961-2155 | 2007-04-10 |
| 1356486591 | Galen R Hasler | Internal Medicine | 350 S Hamilton St, 203, Madison, WI 53703-3861 | 2007-02-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.