Provider Demographics
NPI:1649583485
Name:MALEBRANCHE, ALINE (MD)
Entity type:Individual
Prefix:
First Name:ALINE
Middle Name:
Last Name:MALEBRANCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALINE
Other - Middle Name:
Other - Last Name:AZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2501
Mailing Address - Country:US
Mailing Address - Phone:217-383-3311
Mailing Address - Fax:
Practice Address - Street 1:1120 E WAR MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:630-734-4715
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136910207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-136910Medicaid
ILF400219405Medicare PIN