Provider Demographics
NPI:1700934593
Name:MALIK, SHAZIA A (MD)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:A
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1302
Mailing Address - Country:US
Mailing Address - Phone:602-788-1521
Mailing Address - Fax:602-688-5420
Practice Address - Street 1:1616 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1302
Practice Address - Country:US
Practice Address - Phone:602-788-1521
Practice Address - Fax:602-688-5420
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86679207V00000X
AZ36891207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ256839Medicaid
AZZ120753OtherMEDICARE ID -UNSPECIFIED
AZAZ1700934593OtherBCBS OF AZ
CA00A866790Medicaid
AZ6820310001Medicare NSC
CA00A866790Medicaid
AZ256839Medicaid