Provider Demographics
NPI:1588620884
Name:MALLICK, SALEEM H (MD)
Entity Type:Individual
Prefix:
First Name:SALEEM
Middle Name:H
Last Name:MALLICK
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 1:1601 N BELT LINE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1791
Mailing Address - Country:US
Mailing Address - Phone:972-279-3500
Mailing Address - Fax:972-279-3505
Practice Address - Street 1:1601 N BELT LINE RD STE C
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1791
Practice Address - Country:US
Practice Address - Phone:972-279-3500
Practice Address - Fax:972-279-3505
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6487207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134053111Medicaid
13913OtherPARKLAND
TX85240YOtherBCBS
TX134053112Medicaid
OK100031870AMedicaid
TX134053108Medicaid
B24594Medicare UPIN
TX134053111Medicaid
OK100031870AMedicaid
TX299414YKP5Medicare PIN
TX85240YOtherBCBS