Individual
DR. KRISHNA MALLIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4110 N SCOTTSDALE RD STE 215, SCOTTSDALE, AZ 85251-3635
(855) 804-8800
(480) 907-2994
Mailing address
7181 E CAMELBACK RD, SUITE #303, SCOTTSDALE, AZ 85251-1279
(855) 804-8800
(480) 907-2994
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
37346
AZ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
37346
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z152366
MEDICARE PTAN
AZ
Enumeration date
10/03/2005
Last updated
11/18/2018
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