Provider Demographics
NPI:1740262575
Name:MALEK, JAVAD (MD)
Entity type:Individual
Prefix:MR
First Name:JAVAD
Middle Name:
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 1:11404 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2237
Mailing Address - Country:US
Mailing Address - Phone:813-988-5700
Mailing Address - Fax:813-988-4741
Practice Address - Street 1:11404 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2237
Practice Address - Country:US
Practice Address - Phone:813-988-5700
Practice Address - Fax:813-988-4741
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052929207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12667Medicare UPIN
07195Medicare ID - Type Unspecified