=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972668630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PARVEEN MALIK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2006
-----------------------------------------------------
Last Update Date | 11/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11268 S APOPKA VINELAND RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-6152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-465-1996
-----------------------------------------------------
Fax | 407-465-1997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5633 FOREST RIDGE DR
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33881-0703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-220-6773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 4301065126
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME97637
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------