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Individual

DR. GAUTAM MALIK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3043 N WILTON AVE, 2ND FLOOR, CHICAGO, IL 60657
(773) 296-5424
(773) 296-5280
Mailing address
35318 EAGLE WAY, CHICAGO, IL 60678-1353
(317) 528-4800
(317) 865-1479

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-128378
IL
207R00000X
Internal Medicine Physician
Primary
ME143824
FL
208M00000X
Hospitalist Physician
036-128378
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
IL5686064
MEDICARE PTAN
IL
Enumeration date
05/24/2008
Last updated
10/21/2021
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