Provider Demographics
NPI:1588826366
Name:MALIYIL, JEPSIN ANAT (MD)
Entity Type:Individual
Prefix:
First Name:JEPSIN
Middle Name:ANAT
Last Name:MALIYIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEPSIN
Other - Middle Name:ANAT
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1441 S MIDLOTHIAN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-1474
Practice Address - Fax:972-723-9423
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291412901Medicaid
TXB147363Medicare PIN