Provider Demographics
NPI:1821170580
Name:MALEK, FREIDOON (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:FREIDOON
Middle Name:
Last Name:MALEK
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 COMMODITY PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3101
Mailing Address - Country:US
Mailing Address - Phone:813-343-5500
Mailing Address - Fax:813-343-5506
Practice Address - Street 1:12880 COMMODITY PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3101
Practice Address - Country:US
Practice Address - Phone:813-343-5500
Practice Address - Fax:813-343-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24435208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery