Individual
THAD MALIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1708 SEQUOIA DR, PRESCOTT, AZ 86301-1243
(248) 825-5715
Mailing address
1708 SEQUOIA DR, PRESCOTT, AZ 86301-1243
(248) 825-5715
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
9685638
AZ
Other
Enumeration date
01/04/2019
Last updated
01/04/2019
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