Provider Demographics
NPI:1649242538
Name:MALIS, DAVID JOEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOEL
Last Name:MALIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1499 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3245
Mailing Address - Country:US
Mailing Address - Phone:321-254-5437
Mailing Address - Fax:321-254-4543
Practice Address - Street 1:1499 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3245
Practice Address - Country:US
Practice Address - Phone:321-254-5437
Practice Address - Fax:321-254-4543
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-09-15
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Provider Licenses
StateLicense IDTaxonomies
FLME90348207YP0228X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2067385OtherCIGNA
FLG98130OtherTRICARE SOUTH (HUMANA)
FL2258392OtherMEDICAID HMO - UNITED HEALTH CARE
FL332181OtherMEDICAID HMO - WELLCARE
FL48443OtherBCBS
FL01269821OtherMEDICAID HMO - AMERIGROUP
FL271247400Medicaid
FL6774268OtherAETNA