Provider Demographics
NPI:1891707923
Name:MALICK, ALI M (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:MALICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:360 STATION DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7978
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:815-356-2351
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-8118
Practice Address - Country:US
Practice Address - Phone:815-777-1340
Practice Address - Fax:815-776-7385
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036129438207RR0500X
IL036-129438207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology