Provider Demographics
NPI:1518966886
Name:MALIK, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:107 MONARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-8975
Mailing Address - Country:US
Mailing Address - Phone:919-854-2929
Mailing Address - Fax:
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:STE. 304
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-851-9193
Practice Address - Fax:919-851-9223
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126EHMedicaid
NC0357460OtherCIGNA HEALTHCARE
NC126EHOtherBLUE CROSS BLUE SHIELD
NC7934139OtherAETNA HEALTHCARE
NC89126EHMedicaid
NC0357460OtherCIGNA HEALTHCARE