MEDICARE: RAHUL MALIK DMD

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	122300000X	Dentist	019029285	IL
2	1223G0001X	General Practice Dentistry	10776	CT
3	1223G0001X	General Practice Dentistry	DN1856010	MA

General Provider Information

NPI Number	:	1134481229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHUL MALIK DMD

Provider Business Mailing Address
First Line	:	2702 W DEYOUNG ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-4950
Country	:	US
Telephone Number	:	205-639-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 WEST DEYOUNG STREET
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	205-639-7259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	03/01/2013

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