Provider Demographics
NPI:1376982223
Name:MALIK, FAIZAN IQBAL (MD)
Entity Type:Individual
Prefix:
First Name:FAIZAN
Middle Name:IQBAL
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S TYLER ST STE 230
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2353
Mailing Address - Country:US
Mailing Address - Phone:985-892-9090
Mailing Address - Fax:985-892-9957
Practice Address - Street 1:1203 S TYLER ST STE 230
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-892-9090
Practice Address - Fax:985-892-9957
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458706207R00000X
LA323550207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA323550OtherSTATE LICENSE
PA516366Medicare PIN