Healthcare Provider Details

I. General information

NPI: 1245238534
Provider Name (Legal Business Name): MALIK M MERCHANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

IV. Provider business mailing address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4009
  • Fax: 512-901-3909
Mailing address:
  • Phone: 512-901-4479
  • Fax: 512-901-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM4352
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM4352
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: