Provider Demographics
NPI:1437190287
Name:MALIK, INDU BALA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDU
Middle Name:BALA
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-1528
Mailing Address - Country:US
Mailing Address - Phone:270-472-3262
Mailing Address - Fax:270-472-3263
Practice Address - Street 1:227 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-1528
Practice Address - Country:US
Practice Address - Phone:270-472-3262
Practice Address - Fax:270-472-3263
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23661207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY010012427OtherMEDICARE RAILROAD
KY010012427OtherMEDICARE RAILROAD
TN3818457Medicare PIN
KY1403201Medicare PIN