Provider Demographics
NPI:1245218775
Name:MALAK, OSAMA A (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:A
Last Name:MALAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2382
Mailing Address - Country:US
Mailing Address - Phone:440-989-2066
Mailing Address - Fax:440-989-1153
Practice Address - Street 1:4804 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2382
Practice Address - Country:US
Practice Address - Phone:440-989-2066
Practice Address - Fax:440-989-1153
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4704-M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9482793OtherCIGNA
OHWELLCAREOther352127
OH102875OtherKAISER PERMENENTE
OH000000384379OtherANTHEM
OHP00322841OtherRR MEDICARE
OH2132936Medicaid
OH341961205029OtherCARESOURCE
OH7848067OtherAETNA
OH000000384379OtherANTHEM
OHWELLCAREOther352127