Healthcare Provider Details

I. General information

NPI: 1538185590
Provider Name (Legal Business Name): KHIZAR M MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W GORE ST FL 3
ORLANDO FL
32806-1134
US

IV. Provider business mailing address

32 W GORE ST FL 3
ORLANDO FL
32806-1134
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-5434
  • Fax: 407-345-9765
Mailing address:
  • Phone: 407-352-5434
  • Fax: 407-345-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME88150
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME88150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: