Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2012017436 | MO |
Y | 2081P2900X | Pain Medicine | 74399 | GA |
NPI | 1346595741 |
---|---|
Provider Name | Dr. Ikram Malik |
First Address | Marietta, GA 30060-7902 |
Second Address | Marietta, GA 30060-7902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2012 |
Last Update Date | 12/01/2016 |