Active NPI
Imtiaz A Malik, PA-C
- Physician Assistant
- Rio Rancho, NM
National Provider Identifier
1356322762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2002-0028
- Practice address
- 2400 Unser Blvd SE
Rio Rancho, NM 87124-4740 - Phone
- (505) 559-6100
- Fax
- (505) 559-6101
- NPI assigned
- Nov 11, 2005
- Last updated
- Mar 17, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA2002-0028 | NM | |
| Physician Assistant | 363A00000X | PA2002-0028 | NM | Primary |
Addresses
Primary practice location
2400 Unser Blvd SE
Rio Rancho, NM 87124-4740
Mailing address
PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770
Other practice location 1
715 Martin Luther King Ave NE
Suite 102
Albuquerque, NM 87102-3661
Phone (505) 925-7469
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32486006 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2002-0028 | NM | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of New Mexico | Past | Accepting new patients |
Interoperability endpoints
- imalik102934@direct.phs.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba UNM Cancer Research & Treatment Center
- Clinic/Center
- Albuquerque, NM
- NPI 1285714766
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1356322762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26666",
"address_2": "PHS PROVIDER ENROLLMENT",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871256666",
"telephone_number": "505-923-6770",
"fax_number": "505-923-5354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 UNSER BLVD SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871244740",
"telephone_number": "505-559-6100",
"fax_number": "505-559-6101"
}
],
"practiceLocations": [
{
"address_1": "715 Martin Luther King Ave NE",
"address_2": "Suite 102",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871023661",
"country_code": "US",
"telephone_number": "505-925-7469",
"fax_number": "505-925-7503",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MALIK",
"first_name": "IMTIAZ",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-11",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NM",
"license": "PA2002-0028",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "PA2002-0028",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32486006",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.