Healthcare Provider Details

I. General information

NPI: 1356342695
Provider Name (Legal Business Name): MALIK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 HIGHWAY 61
FESTUS MO
63028-4107
US

IV. Provider business mailing address

2732 BLOOMFIELD RD
CAPE GIRARDEAU MO
63703-6302
US

V. Phone/Fax

Practice location:
  • Phone: 636-937-3500
  • Fax: 636-931-2646
Mailing address:
  • Phone: 573-335-3044
  • Fax: 573-335-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029594
License Number StateMO

VIII. Authorized Official

Name: MR. SHAFIQ MALIK
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 573-335-3044