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Organization
MALIK EYE INSTITUTE LLC
Active
Organization
MALIK EYE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RANAE D BERGMAN (OFFICE MANAGER)
(815) 399-2190
Entity
Organization
Contact information
Practice address
4857 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 399-0599
(815) 399-2499
Mailing address
4857 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 399-0599
(815) 399-2499
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036110588
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214298
PTAN
IL
Enumeration date
11/28/2012
Last updated
09/06/2013
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