MEDICARE: DR. SHASHI KANTA MALIK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	SM045356	MI

General Provider Information

NPI Number	:	1386633931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHASHI KANTA MALIK M.D.

Provider Business Mailing Address
First Line	:	2176 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2405
Country	:	US
Telephone Number	:	313-381-0713
Fax Number	:	313-381-1977

Provider Business Practice Location Address
First Line	:	2176 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2405
Country	:	US
Telephone Number	:	313-381-0713
Fax Number	:	313-381-1977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	02/04/2010

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