Provider Demographics
NPI:1346595741
Name:MALIK, IKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:IKRAM
Middle Name:
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IKE
Other - Middle Name:
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:201 N HEATHERWILDE BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6448
Mailing Address - Country:US
Mailing Address - Phone:512-738-8811
Mailing Address - Fax:512-738-8811
Practice Address - Street 1:201 N HEATHERWILDE BLVD APT 202
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6448
Practice Address - Country:US
Practice Address - Phone:512-738-8811
Practice Address - Fax:512-290-9213
Is Sole Proprietor?:No
Enumeration Date:2012-07-21
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017436208100000X
GA743992081P2900X
TXS46532081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I254979Medicare PIN