Provider Demographics
NPI:1083830772
Name:MALIK E. MCKANY, M.D. P.C.
Entity Type:Organization
Organization Name:MALIK E. MCKANY, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-858-3800
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-858-3800
Mailing Address - Fax:248-858-3928
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-3800
Practice Address - Fax:248-858-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0630663OtherBLUE CROSS
F07885Medicare UPIN
0630663Medicare ID - Type Unspecified