Provider Demographics
NPI:1134191976
Name:MALKANI, SUNIL MOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:MOHAN
Last Name:MALKANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 CYPRESS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4941
Mailing Address - Country:US
Mailing Address - Phone:239-324-4888
Mailing Address - Fax:877-717-0096
Practice Address - Street 1:9201 CYPRESS LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-9310
Practice Address - Country:US
Practice Address - Phone:239-324-4888
Practice Address - Fax:877-717-0096
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81904207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58642SOtherMEDICARE
FL58642ROtherMEDICARE OTHER
FL58642PMedicare PIN
FL58642OMedicare PIN
FL58642QMedicare PIN
H76646Medicare UPIN