Provider Demographics
NPI:1235389537
Name:MALIK, AISHA MOHSIN (MD)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:MOHSIN
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATTN: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:941-746-3115
Mailing Address - Fax:
Practice Address - Street 1:200 3RD AVENUE WEST
Practice Address - Street 2:SUITE 110
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-746-3115
Practice Address - Fax:941-746-3201
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080121582084N0400X
FLME1357262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology