MEDICARE: IMRAN MALIK MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME107296	FL

General Provider Information

NPI Number	:	1649553793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMRAN MALIK MD LLC

Provider Business Mailing Address
First Line	:	8515 S US HIGHWAY 1
Second Line	:	SUITE 3
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-380-4042
Fax Number	:	772-380-4043

Provider Business Practice Location Address
First Line	:	8515 S US HIGHWAY 1
Second Line	:	SUITE 3
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-380-4042
Fax Number	:	772-380-4043

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. IMRAN M MALIK
Credential	:	MD
Telephone Number	:	772-380-4042

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	11/15/2011

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