Provider Demographics
NPI:1205197910
Name:TAJ A. MALIK DPM PC INC
Entity type:Organization
Organization Name:TAJ A. MALIK DPM PC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAJ
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-397-0999
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:701
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-397-0999
Mailing Address - Fax:216-397-0983
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:701
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-397-0999
Practice Address - Fax:216-397-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81977Medicare UPIN