Provider Demographics
NPI:1760597942
Name:MALIK, AYAZ H (MD)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:H
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 1:777 WALTER REED BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042
Mailing Address - Country:US
Mailing Address - Phone:972-272-0282
Mailing Address - Fax:972-276-6492
Practice Address - Street 1:777 WALTER REED BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:972-272-0282
Practice Address - Fax:972-276-6492
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4166207T00000X
IL036142106207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881OtherMEDICARE GROUP PTAN
TX036166901Medicaid
D66876Medicare UPIN