Provider Demographics
NPI:1730128455
Name:MALIK, SYED (MD PA)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7640
Mailing Address - Country:US
Mailing Address - Phone:407-299-7171
Mailing Address - Fax:407-290-7171
Practice Address - Street 1:710 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7640
Practice Address - Country:US
Practice Address - Phone:407-299-7171
Practice Address - Fax:407-290-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038138100Medicaid
FL02008774OtherRAIL RAOD MEDICARE
FLD57047Medicare UPIN
FL038138100Medicaid