Provider Demographics
NPI:1104839828
Name:GINNIS, MALCOLM HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:HENRY
Last Name:GINNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E HILLSBORO BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4355
Mailing Address - Country:US
Mailing Address - Phone:954-426-1080
Mailing Address - Fax:
Practice Address - Street 1:1500 E HILLSBORO BLVD
Practice Address - Street 2:STE 209
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4355
Practice Address - Country:US
Practice Address - Phone:954-426-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17005207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06956Medicare ID - Type UnspecifiedMEDICARE NUMBER
FLD21131Medicare UPIN