Provider Demographics
NPI:1144566944
Name:MALIK, ALI (DO)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:MALIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3600
Mailing Address - Country:US
Mailing Address - Phone:800-735-1178
Mailing Address - Fax:772-223-6354
Practice Address - Street 1:4243 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3600
Practice Address - Country:US
Practice Address - Phone:800-735-1178
Practice Address - Fax:772-223-6354
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12165208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKXP91OtherBCBS
FL017486500Medicaid
FL017486500Medicaid