Provider Demographics
NPI:1356781348
Name:MALIK, ANEEQA ANGELA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANEEQA
Middle Name:ANGELA
Last Name:MALIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W FLOURNOY ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3337
Mailing Address - Country:US
Mailing Address - Phone:630-290-3596
Mailing Address - Fax:
Practice Address - Street 1:1303 W FLOURNOY ST
Practice Address - Street 2:APT 1R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3337
Practice Address - Country:US
Practice Address - Phone:630-290-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist