Organization
TILAK K MALLIK MD FACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BAISHALI MALLIK (OFFICE MANAGER)
(504) 349-6521
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER BLVD, SUITE S113, MARRERO, LA 70072
(504) 349-6520
(504) 349-6522
Mailing address
1111 MEDICAL CENTER BLVD, SUITE S113, MARRERO, LA 70072
(504) 349-6520
(504) 349-6522
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
4776R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0314839001
CIGNA
LA
05
—
1317926
—
LA
01
—
F6746
BC
LA
Enumeration date
01/30/2007
Last updated
08/22/2020
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