Provider Demographics
NPI:1891834172
Name:MALIK, NADIA (MD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 HERITAGE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5716
Mailing Address - Country:US
Mailing Address - Phone:682-999-8446
Mailing Address - Fax:817-545-4438
Practice Address - Street 1:4100 HERITAGE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5716
Practice Address - Country:US
Practice Address - Phone:682-999-8446
Practice Address - Fax:817-545-4438
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088931207R00000X
TXM9478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.008931OtherSTATE LICENSE
TXM9478OtherTMB