Provider Demographics
NPI:1710901798
Name:MALIK, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
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 1:501 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-1002
Mailing Address - Country:US
Mailing Address - Phone:815-673-2850
Mailing Address - Fax:815-672-0936
Practice Address - Street 1:501 OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-1002
Practice Address - Country:US
Practice Address - Phone:815-673-2850
Practice Address - Fax:815-672-0936
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059723207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059723Medicaid
IL02201538OtherBLUE SHIELD
IL02201538OtherBLUE SHIELD
IL697950Medicare PIN