=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134548241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. AMOL MALANKAR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2014
-----------------------------------------------------
Last Update Date | 08/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7741 NW 7TH ST APT 214
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-702-2848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7741 NW 7TH ST APT 214
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-702-2848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS12758
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------