Provider Demographics
NPI:1134104425
Name:MALIK, PERVEEN F (MD)
Entity Type:Individual
Prefix:
First Name:PERVEEN
Middle Name:F
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:214-590-4105
Mailing Address - Fax:214-266-4162
Practice Address - Street 1:9202 ELAM RD
Practice Address - Street 2:SOUTHEAST DALLAS HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4151
Practice Address - Country:US
Practice Address - Phone:214-266-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139448804Medicaid
TX139448806Medicaid
TX139448811Medicaid
TX139448813Medicaid
TX139448807Medicaid
TX139448810Medicaid
TX139448805Medicaid
TX139448802Medicaid
TX139448801Medicaid
TX139448803Medicaid
TX139448814Medicaid
TX139448816Medicaid
TX139448813Medicaid
TX139448801Medicaid
TX139448802Medicaid