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General NPI Number Information
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NPI Number | 1770534273
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Entity Type | Individual
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Provider Name | RAZA ALI MALIK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 110 S SALEM DR
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City | BARDSTOWN
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State | KY
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Zip | 40004-1761
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Country | US
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Telephone | 502-348-3400
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Fax | 502-349-4745
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Provider Business Mailing Address
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Address Line | 1528 YORKSHIRE DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9191
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Country | US
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Telephone | 270-360-9170
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 33395
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License Number State | KY
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