Provider Demographics
NPI:1104893296
Name:MALIK, IJAZ A (MD)
Entity type:Individual
Prefix:
First Name:IJAZ
Middle Name:A
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 2040
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-2040
Mailing Address - Country:US
Mailing Address - Phone:414-219-7653
Mailing Address - Fax:414-219-7676
Practice Address - Street 1:960 N 12TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-219-7653
Practice Address - Fax:414-219-7676
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32806-020207UN0901X
WI32806207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34064500Medicaid
H27611Medicare UPIN
WI34064500Medicaid
WI000640245Medicare PIN
WI000654475Medicare PIN
WI000660350Medicare PIN
WI000604130Medicare PIN