Provider Demographics
NPI:1023030657
Name:MALIK, SHAHID AHMED (MD)
Entity type:Individual
Prefix:
First Name:SHAHID
Middle Name:AHMED
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:PO BOX 15010
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5010
Mailing Address - Country:US
Mailing Address - Phone:865-541-8187
Mailing Address - Fax:865-541-8286
Practice Address - Street 1:2018 CLINCH AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2301
Practice Address - Country:US
Practice Address - Phone:865-541-8266
Practice Address - Fax:865-541-8553
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN249222080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3078570Medicaid
TN172804OtherTENNCARE SELECT
KY64925449Medicaid
TN3078570Medicaid
TN172804OtherBLUE CROSS BLUE SHIELD
KY64925449Medicaid