Healthcare Provider Details

I. General information

NPI: 1366436875
Provider Name (Legal Business Name): AZHAR ALI MALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E SAN ANTONIO ST SUITE 430E
VICTORIA TX
77901-6050
US

IV. Provider business mailing address

605 E SAN ANTONIO ST SUITE 430E
VICTORIA TX
77901-6050
US

V. Phone/Fax

Practice location:
  • Phone: 361-567-0011
  • Fax: 361-576-4084
Mailing address:
  • Phone: 361-567-0011
  • Fax: 361-576-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM1220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: