MEDICARE: NIS MEDICAL ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639849466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIS MEDICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	3417 SAINT JAMES CT
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-1893
Country	:	US
Telephone Number	:	631-882-4751
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 SAGEBRUSH DR STE 101
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-4670
Country	:	US
Telephone Number	:	972-539-4875
Fax Number	:	972-539-3488

Authorized Official
Title or Position	:	MD
Name	:	DR. NAZIA MALICK
Credential	:	MD
Telephone Number	:	631-882-4751

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/30/2021

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