Healthcare Provider Details

I. General information

NPI: 1427979988
Provider Name (Legal Business Name): MALEK KHAWAJA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

IV. Provider business mailing address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1057
  • Fax:
Mailing address:
  • Phone: 239-343-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: