Provider Demographics
NPI:1518992429
Name:MALIK, AYAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:A
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AYAZ
Other - Middle Name:A
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10012 KENNERLY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-4325
Mailing Address - Fax:314-525-4365
Practice Address - Street 1:10012 KENNERLY RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-525-4325
Practice Address - Fax:314-525-4365
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1089882086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208010215Medicaid
MOG05280Medicare UPIN
MO000094514Medicare ID - Type UnspecifiedMEDICARE