Provider Demographics
NPI:1760651285
Name:MALIK, IMRAN MUSHTAQ (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:MUSHTAQ
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8515 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3346
Mailing Address - Country:US
Mailing Address - Phone:772-380-4042
Mailing Address - Fax:772-380-4043
Practice Address - Street 1:8515 S US HIGHWAY 1
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3346
Practice Address - Country:US
Practice Address - Phone:772-380-4042
Practice Address - Fax:772-380-4043
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301090215207Q00000X
FLME107296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003235300Medicaid