1376527663 NPI number — GUNWANT S MALLIK MD

Table of content: GUNWANT S MALLIK MD (NPI 1376527663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376527663 NPI number — GUNWANT S MALLIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALLIK
Provider First Name:
GUNWANT
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1376527663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10169 WELLINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43065-7671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-942-0132
Provider Business Mailing Address Fax Number:
614-942-0139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 HIDDEN RAVINES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43065-9883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-942-0132
Provider Business Practice Location Address Fax Number:
614-942-0139
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  35070094 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 208005968 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000518235 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 208005968 . This is a "TRICARE NORTH REGION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 208005968026 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 208005968 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0225723 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208005968 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com