Provider Demographics
NPI:1689788283
Name:MALIK, FAWAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FAWAD
Middle Name:
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4104 24TH ST
Mailing Address - Street 2:# 521
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3615
Mailing Address - Country:US
Mailing Address - Phone:415-775-7766
Mailing Address - Fax:650-259-7556
Practice Address - Street 1:1838 EL CAMINO REAL
Practice Address - Street 2:SUITE 208
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3126
Practice Address - Country:US
Practice Address - Phone:415-775-7766
Practice Address - Fax:650-259-7556
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA819282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI02148Medicare UPIN