MEDICARE: PRO HEALTH DIAGNOSTICS OF NORTH TEXAS PA

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	207RC0000X	Cardiovascular Disease Physician		TX

General Provider Information

NPI Number	:	1659664100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO HEALTH DIAGNOSTICS OF NORTH TEXAS PA

Provider Business Mailing Address
First Line	:	1904 CANTERBURY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3514
Country	:	US
Telephone Number	:	817-919-8703
Fax Number	:	817-336-1954

Provider Business Practice Location Address
First Line	:	1904 CANTERBURY DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3514
Country	:	US
Telephone Number	:	817-919-8703
Fax Number	:	817-336-1954

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMIR Z MALIK
Credential	:	MD
Telephone Number	:	817-919-8703

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	03/06/2012

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