Healthcare Provider Details

I. General information

NPI: 1548260326
Provider Name (Legal Business Name): KIRON MALHOTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MALABAR RD STE A
MALABAR FL
32950
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-312-3468
  • Fax: 321-409-5745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME87211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: