Provider Demographics
NPI:1922348606
Name:MALIK, YASMIN MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:MELISSA
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 1:1904 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:817-707-8703
Mailing Address - Fax:
Practice Address - Street 1:4819 RIVER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-3098
Practice Address - Country:US
Practice Address - Phone:817-626-9744
Practice Address - Fax:817-626-9962
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine