Individual
ANIL MALIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.B.S
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
026312
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578525
—
LA
01
—
4M017F600
MEDICARE - PTAN
LA
Enumeration date
07/20/2006
Last updated
09/27/2013
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