Healthcare Provider Details

I. General information

NPI: 1295897650
Provider Name (Legal Business Name): HIKMAT A MAALIKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 6TH AVE SW
RONAN MT
59864-2600
US

IV. Provider business mailing address

126 6TH AVE SW
RONAN MT
59864-2600
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-3600
  • Fax: 406-676-3738
Mailing address:
  • Phone: 406-676-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10807
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: