Individual
MALIK T BANDEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6811 118TH AVE, KENOSHA, WI 53142-8420
(262) 857-5750
Mailing address
6811 118TH AVE, KENOSHA, WI 53142-8420
(262) 857-5750
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
38678
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32360000
—
WI
Enumeration date
11/02/2005
Last updated
01/11/2024
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