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NPI Code Detail

MEDICARE: GAGAN C MALLIK MD INC

MEDICARE: GAGAN C MALLIK MD INC
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
1207Y00000XOtolaryngology Physician41404TN

Other Identifiers

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

General Provider Information

NPI Number : 1770687873
Entity Type Code : Organization
Provider Name (Legal Business Name) : GAGAN C MALLIK MD INC
Provider Business Mailing Address
First Line : 5162 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1571
Country : US
Telephone Number : 216-406-7268
Fax Number :
Provider Business Practice Location Address
First Line : 5162 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1571
Country : US
Telephone Number : 216-406-7268
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GAGAN C MALLIK
Credential : MD
Telephone Number : 216-406-7268
Provider Enumeration Date : 09/11/2006
Last Update Date : 03/04/2013

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