Organization
AVANTI AYUSH
Active
Other names
Meridian Health Systems
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUBODHU MALLIK MD (MEDICAL DIRECTOR)
(432) 336-0700
Entity
Organization
Contact information
Practice address
237 W 21ST ST, FORT STOCKTON, TX 79735-2531
(432) 336-0700
(432) 336-0704
Mailing address
237 W 21ST ST, FORT STOCKTON, TX 79735-2531
(432) 336-0700
(432) 336-0704
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
K4945
TX
Other
Enumeration date
12/15/2011
Last updated
12/15/2011
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