Healthcare Provider Details

I. General information

NPI: 1144477951
Provider Name (Legal Business Name): HASSAN ELMALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 N MERIDIAN ST SUITE 200
CARMEL IN
46032-1624
US

IV. Provider business mailing address

11455 N MERIDIAN ST SUITE 200
CARMEL IN
46032-1624
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8180
  • Fax: 317-582-8185
Mailing address:
  • Phone: 317-582-8180
  • Fax: 317-582-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01074057A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: