MEDICARE: YASMIN MELISSA MALIK 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	207R00000X	Internal Medicine Physician	L1653	TX

General Provider Information

NPI Number	:	1922348606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMIN MELISSA MALIK M.D.

Provider Business Mailing Address
First Line	:	1904 CANTERBURY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3514
Country	:	US
Telephone Number	:	817-707-8703
Fax Number	:

Provider Business Practice Location Address
First Line	:	4819 RIVER OAKS BLVD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-3098
Country	:	US
Telephone Number	:	817-626-9744
Fax Number	:	817-626-9962

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

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	02/18/2013

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