Healthcare Provider Details

I. General information

NPI: 1104359058
Provider Name (Legal Business Name): MALIK FAKHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE RD STE 104
DEERFIELD BEACH FL
33064-3547
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-5151
  • Fax: 954-786-2311
Mailing address:
  • Phone: 954-786-5151
  • Fax: 954-786-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME162519
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME162519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: