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General NPI Number Information
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NPI Number | 1376918292
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Entity Type | Organization
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Legal Business Name | MAKD HEART & VASCULAR LLC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 1401 8TH AVENUE
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City | FORT WORTH
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State | TX
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Zip | 76104-3915
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Country | US
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Telephone | 817-334-2800
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Fax | 817-820-0094
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Provider Business Mailing Address
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Address Line | 1904 CANTERBURY DRIVE
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City | FORT WORTH
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State | TX
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Zip | 76107-0000
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Country | US
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Telephone | 817-334-2800
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Fax | 817-820-0094
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMIR ZULFIKAR MALIK
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Credential | M.D.
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Telephone | 817-334-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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