MEDICARE: AMIR G ABDELMALIK MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0904X	Nuclear Radiology Physician	28935	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144743923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIR G ABDELMALIK MD PLLC

Provider Business Mailing Address
First Line	:	14024 ROSE LODGE PL
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-2247
Country	:	US
Telephone Number	:	917-757-8549
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 S YALE AVE STE 104
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3317
Country	:	US
Telephone Number	:	918-522-7200
Fax Number	:	918-522-7201

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DR. AMIR G ABDELMALIK
Credential	:	MD
Telephone Number	:	917-757-8549

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	04/30/2018

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