Provider Demographics
NPI:1851735922
Name:MADNI, TARIK DAVID (MD)
Entity Type:Individual
Prefix:
First Name:TARIK
Middle Name:DAVID
Last Name:MADNI
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 1:245 W STATE HIGHWAY 114 STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3639
Mailing Address - Country:US
Mailing Address - Phone:817-912-1200
Mailing Address - Fax:817-997-8791
Practice Address - Street 1:245 W STATE HIGHWAY 114 STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3639
Practice Address - Country:US
Practice Address - Phone:817-912-1200
Practice Address - Fax:817-997-8791
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8549208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty