Healthcare Provider Details

I. General information

NPI: 1295398071
Provider Name (Legal Business Name): AMMAD AMIR MALIK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2203
US

IV. Provider business mailing address

1032 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2203
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-1353
  • Fax: 262-408-5094
Mailing address:
  • Phone: 414-672-1353
  • Fax: 262-408-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82241-21
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number93496
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: