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General NPI Number Information
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NPI Number | 1194731521
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Entity Type | Individual
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Provider Name | GAGAN C MALLIK MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 7575 NORTHCLIFF AVE SUITE 301
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City | BROOKLYN
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State | OH
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Zip | 44144-3267
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Country | US
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Telephone | 216-271-6299
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Fax | 216-271-6299
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Provider Business Mailing Address
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Address Line | 24651 CENTER RIDGE RD SUITE 350
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City | WESTLAKE
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State | OH
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Zip | 44145-5635
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Country | US
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Telephone | 440-895-5056
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Fax | 440-333-2935
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 41404
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License Number State | TN
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