1215216809 NPI number — IMTIAZ A. MALIK, M.D. INC.

Table of content: (NPI 1215216809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215216809 NPI number — IMTIAZ A. MALIK, M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMTIAZ A. MALIK, M.D. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215216809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3303 M ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95348-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-388-1600
Provider Business Mailing Address Fax Number:
209-388-1610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 E YOSEMITE AVE
Provider Second Line Business Practice Location Address:
SUITE B, PMB# 325
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-8039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-388-1600
Provider Business Practice Location Address Fax Number:
209-388-1610
Provider Enumeration Date:
08/12/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALIK
Authorized Official First Name:
IMTIAZ
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
909-223-2075

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  A39816 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A398160 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".