Provider Demographics
NPI:1568413417
Name:MALIK, AMIR ZULFIKAR (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:ZULFIKAR
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 1:1017 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3915
Mailing Address - Country:US
Mailing Address - Phone:817-334-2800
Mailing Address - Fax:817-820-0094
Practice Address - Street 1:1017 12TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3915
Practice Address - Country:US
Practice Address - Phone:817-334-2800
Practice Address - Fax:817-820-0094
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5146207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1298804-04Medicaid
TX5486665OtherAETNA PROVIDER ID
TX86460KOtherBCBS
TX1298804-02Medicaid
TX10024701OtherAMERIGROUP
TX060051192Medicare PIN
TX060051187Medicare PIN
TX86460KMedicare PIN
TX1298804-02Medicaid
TX86474KMedicare PIN