Provider Demographics
NPI:1972584464
Name:ABRAHAM, MALIK (DPM)
Entity type:Individual
Prefix:DR
First Name:MALIK
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 W SALT CREEK LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5001
Mailing Address - Country:US
Mailing Address - Phone:847-870-4200
Mailing Address - Fax:847-870-0059
Practice Address - Street 1:3030 W SALT CREEK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5001
Practice Address - Country:US
Practice Address - Phone:847-870-4200
Practice Address - Fax:847-870-0059
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003708213E00000X
FLPO 3467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0160037081Medicaid
IL01634499OtherBCBS
ILT37000Medicare UPIN
IL01634499OtherBCBS
ILK32682Medicare PIN
IL0160037081Medicaid