Healthcare Provider Details

I. General information

NPI: 1518909605
Provider Name (Legal Business Name): SHAMIM A MALIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DELTA MEMORIAL HOSPITAL 811 HIGHWAY 65 SOUTH
DUMAS AR
71639
US

IV. Provider business mailing address

1325 HEARTWOOD ST
WHITE HALL AR
71602
US

V. Phone/Fax

Practice location:
  • Phone: 870-382-8234
  • Fax: 870-382-6555
Mailing address:
  • Phone: 870-543-9820
  • Fax: 870-534-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE0062
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: