Provider Demographics
NPI:1326623653
Name:MALIK, SUMERA NAWAZ
Entity Type:Individual
Prefix:
First Name:SUMERA
Middle Name:NAWAZ
Last Name:MALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8454 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7454
Mailing Address - Country:US
Mailing Address - Phone:810-333-6429
Mailing Address - Fax:
Practice Address - Street 1:G3201 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3696
Practice Address - Country:US
Practice Address - Phone:810-732-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility