| Tilak K Mallik Md Face Llc | |
|
1111 Medical Center Blvd Suite S113 Marrero LA 70072 | |
| (504) 349-6520 | |
| (504) 349-6522 |
| Full Name | Tilak K Mallik Md Face Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1111 Medical Center Blvd, Marrero, Louisiana |
| Authorized Official Name and Position | Baishali Mallik (OFFICE MANAGER) |
| Authorized Official Contact | 5043496521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tilak K Mallik Md Face Llc 1111 Medical Center Blvd Suite S113 Marrero LA 70072 Ph: (504) 349-6520 | Tilak K Mallik Md Face Llc 1111 Medical Center Blvd Suite S113 Marrero LA 70072 Ph: (504) 349-6520 |
| NPI Number | 1568508976 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7315923505 |
|---|---|
| Medicare Enrollment ID | O20040628001169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568508976 | NPI | - | NPPES |
| 0314839001 | Other | LA | CIGNA |
| 1317926 | Medicaid | LA | |
| F6746 | Other | LA | BC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 4776R (Louisiana) | Primary |
| Provider Name | Tilak K Mallik |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1437160959 PECOS PAC ID: 0648256834 Enrollment ID: I20040628001198 |
| Provider Name | Maria Azucena M Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710146196 PECOS PAC ID: 9931234598 Enrollment ID: I20100322000167 |
| Provider Name | Maria A Incer Obando |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1194777078 PECOS PAC ID: 6204866619 Enrollment ID: I20110826000071 |
| Provider Name | Michelle Haggar |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1770757007 PECOS PAC ID: 9739300864 Enrollment ID: I20141014002403 |
| Provider Name | Gabriela Marie Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366095465 PECOS PAC ID: 0749519122 Enrollment ID: I20190910002639 |
| Provider Name | Allison Ravassipour |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992329973 PECOS PAC ID: 5395160709 Enrollment ID: I20200803000361 |
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