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General NPI Number Information
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NPI Number | 1770687873
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Entity Type | Organization
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Legal Business Name | GAGAN C MALLIK MD INC
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 5162 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44127-1571
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Country | US
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Telephone | 216-406-7268
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Fax |
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Provider Business Mailing Address
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Address Line | 5162 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44127-1571
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Country | US
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Telephone | 216-406-7268
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAGAN C MALLIK
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Credential | MD
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Telephone | 216-406-7268
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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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