Healthcare Provider Details

I. General information

NPI: 1285214858
Provider Name (Legal Business Name): AHSEN AFTAB MALIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

IV. Provider business mailing address

43634 NOWLAND DR
CANTON MI
48188-1787
US

V. Phone/Fax

Practice location:
  • Phone: 734-654-2169
  • Fax:
Mailing address:
  • Phone: 734-673-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600855
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: