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General NPI Number Information
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NPI Number | 1609872670
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Entity Type | Individual
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Provider Name | AZHAR A MALIK M.D
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 12662 TELECOM DR
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-0935
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Country | US
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Telephone | 813-910-0030
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Fax | 813-971-6473
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Provider Business Mailing Address
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Address Line | 511 MEDICAL OAKS AVE
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City | BRANDON
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State | FL
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Zip | 33511-5961
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Country | US
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Telephone | 813-681-8212
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Fax | 813-654-0478
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME82487
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME82487
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License Number State | FL
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