Provider Demographics
NPI:1396705315
Name:MALKI, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MALKI
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 1:707 PLATINUM PT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5702
Mailing Address - Country:US
Mailing Address - Phone:407-878-0910
Mailing Address - Fax:407-878-0911
Practice Address - Street 1:707 PLATINUM PT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5702
Practice Address - Country:US
Practice Address - Phone:407-878-0910
Practice Address - Fax:407-878-0911
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258856100Medicaid
FL28869OtherBCBS
FLME0069625OtherVHN
FL258856100Medicaid
FLAA805OtherPTAN
FL258856100Medicaid
FLAA805OtherPTAN