Provider Demographics
NPI:1679538557
Name:ADIB, MALAK S (MD)
Entity type:Individual
Prefix:
First Name:MALAK
Middle Name:S
Last Name:ADIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-914-7044
Mailing Address - Fax:937-522-7595
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3492
Practice Address - Country:US
Practice Address - Phone:937-531-5020
Practice Address - Fax:937-298-4385
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070170S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2012495Medicaid
OH0821522Medicare PIN
OH0821524Medicare PIN
OH2012495Medicaid
OH0821525Medicare PIN
OH0821526Medicare PIN
OHG07148Medicare UPIN
OH0821527Medicare PIN
OHH049090Medicare PIN