Organization
GAGAN C MALLIK MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAGAN C MALLIK MD (OWNER)
(216) 406-7268
Entity
Organization
Contact information
Practice address
5162 BROADWAY AVE, CLEVELAND, OH 44127-1571
(216) 406-7268
Mailing address
5162 BROADWAY AVE, CLEVELAND, OH 44127-1571
(216) 406-7268
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
41404
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3735527
—
TN
Enumeration date
09/11/2006
Last updated
03/04/2013
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