Healthcare Provider Details

I. General information

NPI: 1356919708
Provider Name (Legal Business Name): MALIK ABOULEISH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BOULEVARD, 5.504 JENNIE SEALY HOSPITAL 5.504 JENNIE SEALY HOSPITAL
GALVESTON TX
77555-0877
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 409-266-7856
  • Fax:
Mailing address:
  • Phone: 409-772-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10076970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: