Provider Demographics
NPI:1881939858
Name:AWAIS MALIK MD FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:AWAIS MALIK MD FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AWAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-693-3676
Mailing Address - Street 1:470 BRIDGEPORT AVE # J
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4167
Mailing Address - Country:US
Mailing Address - Phone:203-693-3676
Mailing Address - Fax:203-876-9334
Practice Address - Street 1:470 BRIDGEPORT AVE # J
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4167
Practice Address - Country:US
Practice Address - Phone:203-693-3676
Practice Address - Fax:203-876-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty