NPIMap

Organization Active NPI

Fareha N. Malik, M.D. LLC

  • Child & Adolescent Psychiatry Physician
  • Rockford, IL
National Provider Identifier
1528195013
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
FAREHA N. MALIK, M.D. LLC
Practice address
3865 N. Mulford Rd.
Rockford, IL 61114-5603
Phone
(815) 399-2190
Fax
(815) 399-5543
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Fareha N. Malik, M.D.NPI 1780692038
Title
Owner
Phone
(815) 399-2190

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X IL Primary

Addresses

Primary practice location

3865 N. Mulford Rd.
Rockford, IL 61114-5603

Mailing address

3865 N. Mulford Rd.
Rockford, IL 61114-5603
Phone (815) 399-2190

Other identifiers 1

IdentifierTypeStateIssuer
I21229OtherILUPIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091104000556 IL Part B Supplier - Clinic/Group Practice 5193863587 Receives reassigned benefits from 13 practitioners
Practice locations: Elgin, IL

National Provider Directory

National Provider Directory

Locations

2130 Point Blvd
Ste 200
Elgin, IL 60123
Phone (847) 783-0307

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1528195013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3865 N. MULFORD RD.",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145603",
            "telephone_number": "815-399-2190",
            "fax_number": "815-399-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3865 N. MULFORD RD.",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145603",
            "telephone_number": "815-399-2190",
            "fax_number": "815-399-5543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAREHA N. MALIK, M.D. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "FAREHA",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-399-2190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "I21229",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.