Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1003505 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1003505 | TX |
NPI | 1215541768 |
---|---|
Provider Name | Mrs. Punam Malani |
First Address | Allen, TX 75013-4953 |
Second Address | Allen, TX 75013-4953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 21/04/2021 |