Provider Demographics
NPI:1952300584
Name:MALIK, ABDUL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:M
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:MAJID
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:574-335-8707
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:60101 BODNAR BLVD STE 100B
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9340
Practice Address - Country:US
Practice Address - Phone:574-335-8800
Practice Address - Fax:574-335-0613
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054291A2084P0800X, 2084S0012X
MI43011135802084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200371940AMedicaid
IN236040052OtherMEDICARE PTAN
IN261970071OtherMEDICARE PTAN
IN000000645559OtherANTHEM OUT PATIENT SLEEP CLINIC
IN1102537324OtherANTHEM
IN169380070OtherMEDICARE PTAN
MI4301113580OtherLICENSE
IN200371940AMedicaid