Provider Demographics
NPI:1932207461
Name:MALIK, AMER R (MD)
Entity Type:Individual
Prefix:DR
First Name:AMER
Middle Name:R
Last Name:MALIK
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:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0878
Mailing Address - Country:US
Mailing Address - Phone:850-271-3006
Mailing Address - Fax:850-271-4113
Practice Address - Street 1:1000 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2356
Practice Address - Country:US
Practice Address - Phone:850-271-3006
Practice Address - Fax:850-271-4113
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070969174400000X
FLME70969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250121001Medicaid
FL32237CMedicare ID - Type Unspecified
FL250121001Medicaid