Healthcare Provider Details

I. General information

NPI: 1891707923
Provider Name (Legal Business Name): ALI M MALICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
GALENA IL
61036-8118
US

IV. Provider business mailing address

360 STATION DR
CRYSTAL LAKE IL
60014-7978
US

V. Phone/Fax

Practice location:
  • Phone: 815-777-1340
  • Fax: 815-776-7385
Mailing address:
  • Phone: 815-338-6600
  • Fax: 815-356-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036129438
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036-129438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: