Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2021013385 | MO |
Y | 111NI0900X | Internist | 2021013385 | MO |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 2021013385 | MO |
NPI | 1063998862 |
---|---|
Provider Name | Dr. Is-Haq Malik |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2018 |
Last Update Date | 07/07/2021 |