Provider Demographics
NPI:1013112440
Name:MALIK, MEHREEN AMJAD (MD)
Entity type:Individual
Prefix:
First Name:MEHREEN
Middle Name:AMJAD
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST FL 3
Practice Address - Street 2:COPC ADMINISTRATION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-266-1000
Practice Address - Fax:214-266-1246
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184901011Medicaid
TX184901013Medicaid
TX184901017Medicaid
TX184901022Medicaid
TX8W8855OtherBLUE CROSS BLUE SHIELD
TX184901004Medicaid
TX184901023Medicaid
TX184901005Medicaid
TX184901007Medicaid
TX184901014Medicaid
TX184901021Medicaid
TX184901024Medicaid
TX184901003Medicaid
TX184901012Medicaid
TX184901020Medicaid
TX184901002Medicaid
TX184901006Medicaid
TX184901009Medicaid
TX184901008Medicaid
TX184901001Medicaid
TX184901010Medicaid
TX184901016Medicaid
TX184901015Medicaid
TX184901019Medicaid
TX184901025Medicaid
TX184901021Medicaid