Healthcare Provider Details

I. General information

NPI: 1992269351
Provider Name (Legal Business Name): SOUTH LAKE ARTHRITIS AND RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 S HWY 27 STE B
CLERMONT FL
34711-7919
US

IV. Provider business mailing address

3721 S HWY 27 STE B
CLERMONT FL
34711-7919
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-0191
  • Fax: 330-403-6757
Mailing address:
  • Phone: 612-607-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. USMAN TANVEER MALIK
Title or Position: OWNER
Credential: MD
Phone: 612-607-9564