Provider Demographics
NPI:1114592169
Name:HAMMAD, MALIK
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:HAMMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16861 THACKERY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-4451
Mailing Address - Country:US
Mailing Address - Phone:708-663-4675
Mailing Address - Fax:
Practice Address - Street 1:16861 THACKERY AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-4451
Practice Address - Country:US
Practice Address - Phone:708-663-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver