MEDICARE: DR. HENRYK T MALCZAK D.O

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	208D00000X	General Practice Physician	OS6110	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS6110	OTHER	FL	FLORIDA OSTEOPATHIC LICEN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912008145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRYK T MALCZAK D.O

Provider Business Mailing Address
First Line	:	425 W COLONIAL DR STE 303
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6863
Country	:	US
Telephone Number	:	321-332-6947
Fax Number	:	407-286-4515

Provider Business Practice Location Address
First Line	:	550 POPE AVE NW STE 200
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4679
Country	:	US
Telephone Number	:	863-299-2630
Fax Number	:	407-285-4515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	05/17/2024

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