MEDICARE: SHASHI K MALIK, MD, PC

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1124363080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHASHI K MALIK, MD, PC

Provider Business Mailing Address
First Line	:	2176 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2176 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2405
Country	:	US
Telephone Number	:	313-381-0713
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHASHI KANTA MALIK
Credential	:	M.D.
Telephone Number	:	313-381-0713

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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