Provider Demographics
NPI:1548335185
Name:MALIK, IFTIKHAR A (MD)
Entity type:Individual
Prefix:DR
First Name:IFTIKHAR
Middle Name:A
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST STE 7
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3758
Mailing Address - Country:US
Mailing Address - Phone:209-941-0791
Mailing Address - Fax:209-941-0260
Practice Address - Street 1:2800 N CALIFORNIA ST STE 7
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3758
Practice Address - Country:US
Practice Address - Phone:209-941-0791
Practice Address - Fax:209-941-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA382230207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100008936OtherRAILROAD MEDICARE
CA00A382230OtherCOMMERICAL INSURANCE
CA00A382230Medicaid
CA00A382230Medicaid
CA00A382230OtherCOMMERICAL INSURANCE
CAA28569Medicare UPIN