MEDICARE: MR. HUMZA IMAM MALIK LSW

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	1041C0700X	Clinical Social Worker	150.114047	IL

General Provider Information

NPI Number	:	1477395697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUMZA IMAM MALIK LSW

Provider Business Mailing Address
First Line	:	1433 W CARMEN AVE APT 3D
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2882
Country	:	US
Telephone Number	:	440-289-3129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 W CARMEN AVE APT 3D
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2882
Country	:	US
Telephone Number	:	440-289-3129
Fax Number	:

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/02/2026

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