MEDICARE: DR. SHAHID Q MALLICK M.D.

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	207RP1001X	Pulmonary Disease Physician	J8042	TX

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	:	1396738415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHID Q MALLICK M.D.

Provider Business Mailing Address
First Line	:	3511 TOWN CENTER BLVD S
Second Line	:	SUITE #102
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-1285
Country	:	US
Telephone Number	:	281-491-1185
Fax Number	:	281-491-1247

Provider Business Practice Location Address
First Line	:	3511 TOWN CENTER BLVD S
Second Line	:	SUITE #102
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-1285
Country	:	US
Telephone Number	:	281-491-1185
Fax Number	:	281-491-1247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	10/09/2007

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