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1952300584

NPI Code Detail

MEDICARE: DR. ABDUL M MALIK M.D.

MEDICARE: DR. ABDUL M 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	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	4301113580	MI
2	2084P0800X	Psychiatry Physician	01054291A	IN
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	01054291A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	169380070	OTHER	IN	MEDICARE PTAN
6	261970071	OTHER	IN	MEDICARE PTAN
7	236040052	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1102537324	OTHER	IN	ANTHEM
4	000000645559	OTHER	IN	ANTHEM OUT PATIENT SLEEP CLINIC
5	4301113580	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1952300584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDUL M MALIK M.D.

Provider Business Mailing Address
First Line	:	707 CEDAR ST STE 405
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-2059
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0741

Provider Business Practice Location Address
First Line	:	550 MUNSON AVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3580
Country	:	US
Telephone Number	:	231-935-6600
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/23/2025

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Directions to “ DR. ABDUL M MALIK M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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