Provider Demographics
NPI:1144743923
Name:AMIR G ABDELMALIK MD PLLC
Entity Type:Organization
Organization Name:AMIR G ABDELMALIK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABDELMALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-757-8549
Mailing Address - Street 1:14024 ROSE LODGE PL
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2247
Mailing Address - Country:US
Mailing Address - Phone:917-757-8549
Mailing Address - Fax:
Practice Address - Street 1:6711 S YALE AVE STE 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3317
Practice Address - Country:US
Practice Address - Phone:918-522-7200
Practice Address - Fax:918-522-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK289352085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200419510AMedicaid