=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427755040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRINCETON MEDICAL ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2023
-----------------------------------------------------
Last Update Date | 02/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 MEDICAL CENTER DR STE 240-250
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-1766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-886-8537
-----------------------------------------------------
Fax | 469-930-0197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 MISTLETOE DR
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-886-8537
-----------------------------------------------------
Fax | 469-930-0197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAYYAB MALIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-886-8537
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------