Provider Demographics
NPI:1952609299
Name:MALKAN, KAJAL CHIRAG (PA)
Entity type:Individual
Prefix:MRS
First Name:KAJAL
Middle Name:CHIRAG
Last Name:MALKAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20555 BARTLETT DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1720
Mailing Address - Country:US
Mailing Address - Phone:516-619-6313
Mailing Address - Fax:
Practice Address - Street 1:555 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-1100
Practice Address - Country:US
Practice Address - Phone:414-566-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant