Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 32045 | KY |
Y | 207RA0401X | Internist - Addiction Medicine | 32045 | KY |
NPI | 1659434728 |
---|---|
Provider Name | Tariq K Malik |
First Address | Beaver Dam, KY 42320-8955 |
Second Address | Beaver Dam, KY 42320-8955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G42445 | (02) | KY |