Provider Demographics
NPI:1942650130
Name:NASSAN, MALIK (MBBS)
Entity Type:Individual
Prefix:DR
First Name:MALIK
Middle Name:
Last Name:NASSAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 945
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2952
Mailing Address - Country:US
Mailing Address - Phone:312-695-9627
Mailing Address - Fax:312-695-6072
Practice Address - Street 1:676 N SAINT CLAIR ST STE 945
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2952
Practice Address - Country:US
Practice Address - Phone:312-695-9627
Practice Address - Fax:312-695-6072
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN275062084P0800X
MN643592084P0800X
IL0361565372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry