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NPI Code Detail

MEDICARE: GHAZALA SADRUDDIN MALIK M.D.

MEDICARE: GHAZALA SADRUDDIN MALIK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician35070914MOH
2207P00000XEmergency Medicine Physician35.070914OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00074637OTHERRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000317069OTHEROHBCBS

General Provider Information

NPI Number : 1124076336
Entity Type Code : Individual
Provider Name (Legal Business Name) : GHAZALA SADRUDDIN MALIK M.D.
Provider Business Mailing Address
First Line : 4750 HEMPSTEAD STATION DR
Second Line :
City : KETTERING
State : OH
Zip : 45429-5164
Country : US
Telephone Number : 800-875-0136
Fax Number : 937-619-4231
Provider Business Practice Location Address
First Line : 630 EATON AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45013-2767
Country : US
Telephone Number : 513-867-2270
Fax Number : 513-867-2581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 12/15/2020

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Directions to “ GHAZALA SADRUDDIN MALIK M.D.” Practice Location

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