Provider Demographics
NPI:1699730572
Name:MALIK, KHALIL MAHMOOD (MD)
Entity type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:MAHMOOD
Last Name:MALIK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 GWYNEDD LEA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1921
Mailing Address - Country:US
Mailing Address - Phone:267-218-3427
Mailing Address - Fax:
Practice Address - Street 1:601 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2947
Practice Address - Country:US
Practice Address - Phone:215-361-5070
Practice Address - Fax:215-412-4811
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035345E207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1047825Medicaid
PAD71624Medicare UPIN
PA1047825Medicaid