MEDICARE: CHARRU MALIK P.T.

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	225100000X	Physical Therapist	05009076A	IN
2	225100000X	Physical Therapist	5501012923	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000491681	OTHER	IN	ANTHEM - MBWOUDE
2	000000491371	OTHER	IN	ANTHEM - 1ST AID PLUS
3	000000491408	OTHER	IN	ANTHEM - APT PLUS

General Provider Information

NPI Number	:	1639263155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARRU MALIK P.T.

Provider Business Mailing Address
First Line	:	1534 119TH ST
Second Line	:
City	:	WHITING
State	:	IN
Zip	:	46394-1733
Country	:	US
Telephone Number	:	219-864-3300
Fax Number	:	219-864-2569

Provider Business Practice Location Address
First Line	:	1534 119TH ST
Second Line	:
City	:	WHITING
State	:	IN
Zip	:	46394-1733
Country	:	US
Telephone Number	:	219-655-5285
Fax Number	:	219-655-5472

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/11/2017

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Directions to “ CHARRU MALIK P.T.” Practice Location

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