Provider Demographics
NPI:1659664100
Name:PRO HEALTH DIAGNOSTICS OF NORTH TEXAS PA
Entity Type:Organization
Organization Name:PRO HEALTH DIAGNOSTICS OF NORTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-919-8703
Mailing Address - Street 1:1904 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3514
Mailing Address - Country:US
Mailing Address - Phone:817-919-8703
Mailing Address - Fax:817-336-1954
Practice Address - Street 1:1904 CANTERBURY DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3514
Practice Address - Country:US
Practice Address - Phone:817-919-8703
Practice Address - Fax:817-336-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty