Provider Demographics
NPI:1679580807
Name:MALIK, MASUD IQUBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MASUD
Middle Name:IQUBAL
Last Name:MALIK
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 1:3865 N MULFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114
Mailing Address - Country:US
Mailing Address - Phone:815-399-2190
Mailing Address - Fax:815-399-5543
Practice Address - Street 1:3865 NORTH MULFORD ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114
Practice Address - Country:US
Practice Address - Phone:815-399-2190
Practice Address - Fax:815-399-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110588207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214298OtherMEDICARE ID UNSPECIFIED
IL036110588Medicaid
IL214298OtherMEDICARE ID UNSPECIFIED
ILK32055Medicare PIN