Provider Demographics
NPI:1417145970
Name:SHAHID MALLICK MD PA DBA SWEETWATER PULMONARY & SLEEP DISORDER CENTER
Entity Type:Organization
Organization Name:SHAHID MALLICK MD PA DBA SWEETWATER PULMONARY & SLEEP DISORDER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MALLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-491-1185
Mailing Address - Street 1:3511 TOWN CENTER BLVD S
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1285
Mailing Address - Country:US
Mailing Address - Phone:281-491-1185
Mailing Address - Fax:281-491-1247
Practice Address - Street 1:3511 TOWN CENTER BLVD S
Practice Address - Street 2:SUITE #102
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1285
Practice Address - Country:US
Practice Address - Phone:281-491-1185
Practice Address - Fax:281-491-1247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHID MALLICK MD PA DBA SWEETWATER PULMONARY & SLEEP DISORDER CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-10
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8042207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122372903Medicaid
TX00895JMedicare PIN
TXG00247Medicare UPIN