Provider Demographics
NPI:1407315187
Name:MALHOTRA, IEVA (MD)
Entity Type:Individual
Prefix:DR
First Name:IEVA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IEVA
Other - Middle Name:
Other - Last Name:GULBICKAITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14875 NW 77TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2568
Mailing Address - Country:US
Mailing Address - Phone:516-543-2938
Mailing Address - Fax:
Practice Address - Street 1:14875 NW 77TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2568
Practice Address - Country:US
Practice Address - Phone:516-543-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162498207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine