Provider Demographics
NPI:1104861376
Name:MALIK, GHAUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAUS
Middle Name:M
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12945 N HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-9323
Mailing Address - Country:US
Mailing Address - Phone:209-334-3923
Mailing Address - Fax:209-334-3985
Practice Address - Street 1:12945 N HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-9323
Practice Address - Country:US
Practice Address - Phone:209-334-3923
Practice Address - Fax:209-334-3985
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA336430207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOA336430Medicare ID - Type Unspecified