Provider Demographics
NPI:1578767950
Name:ABDULMALIK, AMEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:AMEEN
Middle Name:A
Last Name:ABDULMALIK
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 1:15150 FORT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1302
Mailing Address - Country:US
Mailing Address - Phone:734-282-4800
Mailing Address - Fax:734-282-9302
Practice Address - Street 1:15150 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1302
Practice Address - Country:US
Practice Address - Phone:734-282-4800
Practice Address - Fax:734-282-9302
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078156207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11783199OtherCAQH
MI4301078156OtherSTATE LICENSE #
MIAA078156OtherMI STATE MEDICAL LICENSE
MI1578767950OtherBCBS TYPE 1 NPI
MI1578767950Medicaid
MI11783199OtherCAQH