Provider Demographics
NPI:1306866058
Name:MALIK, SHAHID SHAFIQ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:SHAFIQ
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17935 CACHET ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2703
Mailing Address - Country:US
Mailing Address - Phone:813-633-9700
Mailing Address - Fax:813-633-9733
Practice Address - Street 1:733 CORTARO DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-633-9700
Practice Address - Fax:813-633-9733
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 47456207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00264250OtherRAILROAD MEDICARE
FL051335100Medicaid
FL051335100Medicaid
FLE59541Medicare UPIN