Provider Demographics
NPI:1336232420
Name:MALIK, SALEEM I (MD)
Entity Type:Individual
Prefix:
First Name:SALEEM
Middle Name:I
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2500
Practice Address - Fax:682-885-2510
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL65092084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10010584OtherAMERIGROUP PIN
TX158188602Medicaid
TX21146971OtherFIRSTHEALTH PIN
TX133483100OtherFIRSTCARE PIN
TX7001395OtherAETNA PIN
TX00U87ZOtherBCBSTX GRP PIN
TX137345810Medicaid
1750369203OtherGRP NPI NUMBER
TX8A9112OtherBCBSTX IND PIN
TX140442852Medicaid
TX158188601Medicaid
TX123997OtherSUPERIOR PIN
TX2316734OtherUHC PIN
TX4531855OtherCIGNA PIN
TX7001395OtherAETNA PIN
TX133483100OtherFIRSTCARE PIN
TX2316734OtherUHC PIN