Provider Demographics
NPI:1902852312
Name:MALIK, RAZIA BEGUM (MD)
Entity Type:Individual
Prefix:
First Name:RAZIA
Middle Name:BEGUM
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
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
Mailing Address - Country:US
Mailing Address - Phone:407-295-2986
Mailing Address - Fax:407-290-8464
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:407-295-2986
Practice Address - Fax:407-290-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040132207Q00000X
FLME40132208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068526700Medicaid
FL47609AMedicare PIN
FLD85788Medicare UPIN