Basic Information
| Provider Information | |||||||||
| NPI: | 1710974878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALIK | ||||||||
| FirstName: | AJAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 BAY PARK DR | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436164920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196907653 | ||||||||
| FaxNumber: | 4196977726 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 BAY PARK DR | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436164920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196907653 | ||||||||
| FaxNumber: | 4196977726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 10/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35083186 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000000555174 | 01 | ANTHEM | OTHER | P00835594 | 01 | RRMC | OTHER | 04097 | 01 | PARAMOUNT | OTHER | 2465069 | 05 | OH | MEDICAID | 7366568 | 01 | AETNA | OTHER |