Healthcare Provider Details

I. General information

NPI: 1922122035
Provider Name (Legal Business Name): ABID MALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 W WARREN AVE
LONGWOOD FL
32750-4002
US

IV. Provider business mailing address

455 W WARREN AVE
LONGWOOD FL
32750-4002
US

V. Phone/Fax

Practice location:
  • Phone: 407-262-2220
  • Fax: 407-834-5011
Mailing address:
  • Phone: 407-262-2220
  • Fax: 407-834-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberME105000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-32200
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME105000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: