MEDICARE: DR. IFTIKHAR A 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
1	207RG0100X	Gastroenterology Physician	A382230	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100008936	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00A382230	OTHER	CA	COMMERICAL INSURANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548335185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFTIKHAR A MALIK M.D.

Provider Business Mailing Address
First Line	:	2800 N CALIFORNIA ST STE 7
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-3758
Country	:	US
Telephone Number	:	209-941-0791
Fax Number	:	209-941-0260

Provider Business Practice Location Address
First Line	:	2800 N CALIFORNIA ST STE 7
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-3758
Country	:	US
Telephone Number	:	209-941-0791
Fax Number	:	209-941-0260

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	04/28/2008

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