Individual
MR. ILYA MALANIY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240-6524
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0865
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP121353
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302607204
—
TX
01
—
8552UJ
BCBS TX
TX
Enumeration date
12/05/2011
Last updated
06/30/2020
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