Healthcare Provider Details

I. General information

NPI: 1295762342
Provider Name (Legal Business Name): NAVEED MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 HIGHWAY 22
MANDEVILLE LA
70471-3310
US

IV. Provider business mailing address

DEPT 165016 P O BOX 62600
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 985-792-7325
  • Fax: 985-792-7327
Mailing address:
  • Phone: 985-792-7325
  • Fax: 985-792-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11873R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number11873R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: