Organization
RADIOLOGY UNLIMITED, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHOLAMREZA MALEK M.D. (OWNER)
(361) 576-3680
Entity
Organization
Contact information
Practice address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 576-3680
(361) 576-4219
Mailing address
PO BOX 3432, VICTORIA, TX 77903-3432
(361) 576-3680
(361) 576-4219
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K9841
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077HS
BCBS OF TX #
TX
Enumeration date
12/15/2005
Last updated
08/22/2020
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