Healthcare Provider Details

I. General information

NPI: 1386995579
Provider Name (Legal Business Name): ALLISON MALIK WIPPERT CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON CHRISTINE MALIK CNIM

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIGHLAND PARK VLG STE 100-225
DALLAS TX
75205
US

IV. Provider business mailing address

25 HIGHLAND PARK VLG SUITE 100-225
DALLAS TX
75205
US

V. Phone/Fax

Practice location:
  • Phone: 214-536-1647
  • Fax: 972-625-2884
Mailing address:
  • Phone: 214-536-1647
  • Fax: 972-625-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: