Healthcare Provider Details

I. General information

NPI: 1609014026
Provider Name (Legal Business Name): MUHAMMAD ADNAN MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

IV. Provider business mailing address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-2000
  • Fax:
Mailing address:
  • Phone: 817-250-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD444874
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036.136076
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number5917
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: