Provider Demographics
NPI:1477870202
Name:MIFAMILIA MEDICAL PLLC
Entity Type:Organization
Organization Name:MIFAMILIA MEDICAL PLLC
Other - Org Name:GRAND PRAIRIE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-342-5757
Mailing Address - Street 1:9090 SKILLMAN
Mailing Address - Street 2:STE 200C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8259
Mailing Address - Country:US
Mailing Address - Phone:214-342-5757
Mailing Address - Fax:
Practice Address - Street 1:928 N BELT LINE RD
Practice Address - Street 2:STE 200
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:972-314-1311
Practice Address - Fax:972-314-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty