MALIK PETERSON, DO DO
NPI 1871396119
Student in an Organized Health Care Education/Training Program in Idaho Falls, ID

Q: What is Malik Peterson, Do's NPI number?

The NPI number for Malik Peterson, Do is 1871396119. It was assigned to this individual provider in the NPPES registry on March 31, 2025.

Q: What is Malik Peterson, Do's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Active since March 31, 2025PECOS Enrolled

3100 CHANNING WAY, IDAHO FALLS, ID 83404(208) 227-2850 Get Directions Write a Review

NPPES record last updated: June 27, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Mar 21, 2026, Mar 31, 2025 (2 updates tracked since 2025).

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About Malik Peterson, Do Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MALIK PETERSON, DO DO (NPI 1871396119) is an individual student in an organized health care education/training program in Idaho Falls, Idaho and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1871396119

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMALIK PETERSON, DOCredential: DO

Location Address3100 CHANNING WAYIdaho Falls, ID 83404-7533

Mailing Address3100 Channing WayIdaho Falls, ID 83404-7533 · (208) 970-1123

Phone(208) 227-2850

Sole ProprietorYes

Enumeration DateMarch 31, 2025

Last NPPES UpdateJune 27, 20262 updates tracked since enumeration

NPPES CertifiedJune 27, 2026

✔ NPI 1871396119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3100 CHANNING WAY, Idaho Falls, ID 83404

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Malik Peterson, Do Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CARL SAMUEL BRAYTON DO

Student in an Organized Health Care Education/Training Program