Healthcare Provider Details

I. General information

NPI: 1205356326
Provider Name (Legal Business Name): VIKRAM MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 TOLL GATE RD STE 203
WARWICK RI
02886-2741
US

IV. Provider business mailing address

470 TOLL GATE RD STE 203
WARWICK RI
02886-2741
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-4960
  • Fax:
Mailing address:
  • Phone: 318-626-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9999999999999
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: