Provider Demographics
NPI:1184638884
Name:MALIK, NASIRA M (MD)
Entity Type:Individual
Prefix:
First Name:NASIRA
Middle Name:M
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 1:1135 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2835
Practice Address - Country:US
Practice Address - Phone:731-479-2606
Practice Address - Fax:731-479-2610
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35637208000000X
TN52411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0270813Medicare PIN
H11770Medicare UPIN