Basic Information
| Provider Information | |||||||||
| NPI: | 1003099813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALIK | ||||||||
| FirstName: | HENNA | ||||||||
| MiddleName: | MUKHTAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 PINECROFT DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812982876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13215 DOTSON RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770704535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818948822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2007 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01064564A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | M8807 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | M8807 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | P01843060 | 01 | TX | RAILROAD | OTHER | 281930205 | 05 | TX | MEDICAID | 281930206 | 05 | TX | MEDICAID |