Healthcare Provider Details

I. General information

NPI: 1659057859
Provider Name (Legal Business Name): BHOOMANYU MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ROBERT JONES WAY
KALAMAZOO MI
49009-1904
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-0400
  • Fax: 269-492-0660
Mailing address:
  • Phone: 269-552-2823
  • Fax: 269-552-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301515257
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.082753
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: