Provider Demographics
NPI:1528195013
Name:FAREHA N. MALIK, M.D. LLC
Entity Type:Organization
Organization Name:FAREHA N. MALIK, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAREHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-399-2190
Mailing Address - Street 1:3865 N. MULFORD RD.
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5603
Mailing Address - Country:US
Mailing Address - Phone:815-399-2190
Mailing Address - Fax:815-399-5543
Practice Address - Street 1:3865 N. MULFORD RD.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5603
Practice Address - Country:US
Practice Address - Phone:815-399-2190
Practice Address - Fax:815-399-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI21229OtherUPIN