Provider Demographics
NPI:1972669752
Name:MALIK, TAJ A (DPM)
Entity Type:Individual
Prefix:
First Name:TAJ
Middle Name:A
Last Name:MALIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-0064
Mailing Address - Country:US
Mailing Address - Phone:216-397-0999
Mailing Address - Fax:216-397-0983
Practice Address - Street 1:5 SEVERANCE CIRCLE
Practice Address - Street 2:SUITE 701
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1590
Practice Address - Country:US
Practice Address - Phone:216-397-0999
Practice Address - Fax:216-397-0983
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002541M213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0718512Medicaid
OH0718512Medicaid