Provider Demographics
NPI:1255354478
Name:MALEK, ALI R (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:R
Last Name:MALEK
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 1:901 VILLAGE BLVD
Mailing Address - Street 2:STE 702
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1947
Mailing Address - Country:US
Mailing Address - Phone:561-882-6214
Mailing Address - Fax:561-882-6216
Practice Address - Street 1:901 VILLAGE BLVD
Practice Address - Street 2:STE 702
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1947
Practice Address - Country:US
Practice Address - Phone:561-882-6214
Practice Address - Fax:561-882-6216
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL247222084N0400X
FLME 85796207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51491OtherBLUE CROSS BLUE SHIELD
FL265180700Medicaid
FL130025970Medicare PIN
FLH31454Medicare UPIN
FL265180700Medicaid