Provider Demographics
NPI:1346278546
Name:MALIK, IMTIAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:IMTIAZ
Middle Name:A
Last Name:MALIK
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 1:731 E YOSEMITE AVE
Mailing Address - Street 2:SUITE B, PMB# 325
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8039
Mailing Address - Country:US
Mailing Address - Phone:209-388-1600
Mailing Address - Fax:209-388-1610
Practice Address - Street 1:3303 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2714
Practice Address - Country:US
Practice Address - Phone:209-388-1600
Practice Address - Fax:209-388-1610
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39816207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398160Medicaid
00A398162Medicare PIN
CA00A398160Medicaid
CADF857XMedicare PIN