Basic Information
| Provider Information | |||||||||
| NPI: | 1669621363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALIK | ||||||||
| FirstName: | FATIMA | ||||||||
| MiddleName: | NADIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5127 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982065127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252583900 | ||||||||
| FaxNumber: | 4252583901 | ||||||||
| Practice Location | |||||||||
| Address1: | 4430 106TH ST SW STE 102 | ||||||||
| Address2: | |||||||||
| City: | MUKILTEO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982754711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254936000 | ||||||||
| FaxNumber: | 4254936015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08363400 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD436251 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD60836518 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 102315576 | 05 | PA | MEDICAID |