Provider Demographics
NPI:1487782462
Name:CANTON CENTER PEDIATRICS
Entity type:Organization
Organization Name:CANTON CENTER PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BAQIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-254-1900
Mailing Address - Street 1:6492 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2660
Mailing Address - Country:US
Mailing Address - Phone:734-254-1900
Mailing Address - Fax:734-254-1951
Practice Address - Street 1:6492 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2660
Practice Address - Country:US
Practice Address - Phone:734-254-1900
Practice Address - Fax:734-254-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010701242080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497816623OtherKAUSER MALIK MD
MI45149710 10Medicaid
MI1568402022OtherBAQIR MALIK MD
MIH31766Medicare UPIN
MI45149710 10Medicaid