Healthcare Provider Details

I. General information

NPI: 1285026393
Provider Name (Legal Business Name): MALIK AND NAZ PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W NORTHGATE DR
IRVING TX
75062-2650
US

IV. Provider business mailing address

346 NOAH TRL
ALLEN TX
75013-6415
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-4460
  • Fax:
Mailing address:
  • Phone: 516-710-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberP0994
License Number StateTX

VIII. Authorized Official

Name: DR. MOHAMMAD I MALIK
Title or Position: MEMBER
Credential: MD
Phone: 516-710-0148