Provider Demographics
NPI:1407974868
Name:MICHAEL E ABDUL-MALAK, MD, LLC
Entity Type:Organization
Organization Name:MICHAEL E ABDUL-MALAK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABDUL-MALAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-347-4561
Mailing Address - Street 1:PO BOX 1318
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0318
Mailing Address - Country:US
Mailing Address - Phone:724-347-4561
Mailing Address - Fax:
Practice Address - Street 1:2151 SHENANGO VALLEY FWY STE A-2
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148
Practice Address - Country:US
Practice Address - Phone:724-347-4561
Practice Address - Fax:724-347-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052122L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14684240005Medicaid
PAF85568Medicare UPIN
PA86659Medicare ID - Type Unspecified