Provider Demographics
NPI:1972574986
Name:MAATOUK, MALEK (MD)
Entity type:Individual
Prefix:
First Name:MALEK
Middle Name:
Last Name:MAATOUK
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 1:1225 E COOLSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-6312
Mailing Address - Country:US
Mailing Address - Phone:219-878-5054
Mailing Address - Fax:219-878-5053
Practice Address - Street 1:1225 E COOLSPRING AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6312
Practice Address - Country:US
Practice Address - Phone:219-878-5054
Practice Address - Fax:219-878-5053
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060123A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000369964OtherANTHEM
P00286172OtherMEDICARE RR
IN200509930Medicaid
IN5710110004Medicare NSC
P00286172OtherMEDICARE RR
IN217230GGMedicare PIN