Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OS12165 | FL |
Y | 2081P2900X | Pain Medicine | OS12165 | FL |
NPI | 1144566944 |
---|---|
Provider Name | Dr. Ali Malik |
First Address | Jensen Beach, FL 34957-3600 |
Second Address | Jensen Beach, FL 34957-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/12/2012 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017486500 | (05) | FL |
KXP91 | BCBS (01) | FL |