Provider Demographics
NPI:1710974878
Name:MALIK, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
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 1:2801 BAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4920
Mailing Address - Country:US
Mailing Address - Phone:419-690-7653
Mailing Address - Fax:419-697-7726
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7653
Practice Address - Fax:419-697-7726
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083186207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7366568OtherAETNA
P00835594OtherRRMC
04097OtherPARAMOUNT
000000555174OtherANTHEM
OH2465069Medicaid
OHH093640Medicare PIN
04097OtherPARAMOUNT