Provider Demographics
NPI:1497747695
Name:MALIK, ABDUS SALAM (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUS
Middle Name:SALAM
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-0340
Mailing Address - Country:US
Mailing Address - Phone:740-808-0700
Mailing Address - Fax:740-654-3380
Practice Address - Street 1:1171 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1303
Practice Address - Country:US
Practice Address - Phone:740-808-0700
Practice Address - Fax:740-477-1315
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350655606207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0937240Medicaid
F65547Medicare UPIN
OH0937240Medicaid
390005149Medicare PIN