Provider Demographics
NPI:1407876220
Name:MALIK, HASSAN M (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:M
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 1:1755 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7040
Mailing Address - Country:US
Mailing Address - Phone:330-836-2828
Mailing Address - Fax:330-836-0959
Practice Address - Street 1:1755 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7040
Practice Address - Country:US
Practice Address - Phone:330-836-2828
Practice Address - Fax:330-836-0959
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherMEDICARE GROUP NUMBER
OH2192167Medicaid
OH1841239274OtherMEDICARE NPI GROUP NUMBER
OH4028683Medicare PIN
OHH21030Medicare UPIN