Provider Demographics
NPI:1639263155
Name:MALIK, CHARRU (PT)
Entity Type:Individual
Prefix:
First Name:CHARRU
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHARRU
Other - Middle Name:
Other - Last Name:CHAUDHRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1534 119TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1733
Mailing Address - Country:US
Mailing Address - Phone:219-864-3300
Mailing Address - Fax:219-864-2569
Practice Address - Street 1:1534 119TH ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1733
Practice Address - Country:US
Practice Address - Phone:219-655-5285
Practice Address - Fax:219-655-5472
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009076A225100000X
MI5501012923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000491681OtherANTHEM - MBWOUDE
IN000000491371OtherANTHEM - 1ST AID PLUS
IN000000491408OtherANTHEM - APT PLUS
IN214690UMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN214680UMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN000000491408OtherANTHEM - APT PLUS