Healthcare Provider Details

I. General information

NPI: 1790103125
Provider Name (Legal Business Name): FATIMA MALIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

10255 N RED OAK
NORTH ROYALTON OH
44133-3381
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-4486
  • Fax:
Mailing address:
  • Phone: 216-526-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number35.132121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: