Healthcare Provider Details

I. General information

NPI: 1770792244
Provider Name (Legal Business Name): ASIF MAHMOOD MALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD DEPT. OF ANESTHESIOLOGY, HF W.BLOOMFIELD HOSPITAL
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

2758 CHARNWOOD DR
TROY MI
48098-2184
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax:
Mailing address:
  • Phone: 248-835-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301078140
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number4301078140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: