Provider Demographics
NPI:1609656313
Name:BARNES, MALIK MARTIZ
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:MARTIZ
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3494 FAIRWAY DR # 0
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1000
Mailing Address - Country:US
Mailing Address - Phone:708-466-7322
Mailing Address - Fax:
Practice Address - Street 1:3494 FAIRWAY DR # 0
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1000
Practice Address - Country:US
Practice Address - Phone:708-466-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home