Provider Demographics
NPI:1215216809
Name:IMTIAZ A. MALIK, M.D. INC.
Entity Type:Organization
Organization Name:IMTIAZ A. MALIK, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IMTIAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-223-2075
Mailing Address - Street 1:3303 M ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2714
Mailing Address - Country:US
Mailing Address - Phone:209-388-1600
Mailing Address - Fax:209-388-1610
Practice Address - Street 1:731 E YOSEMITE AVE
Practice Address - Street 2:SUITE B, PMB# 325
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8039
Practice Address - Country:US
Practice Address - Phone:209-388-1600
Practice Address - Fax:209-388-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39816207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398160Medicaid
CAH08048Medicare UPIN
CAFL368AMedicare PIN