MEDICARE: DR. LARISA MALYKH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME79246	FL

General Provider Information

NPI Number	:	1134191539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARISA MALYKH MD

Provider Business Mailing Address
First Line	:	6100 SAINT JOHNS AVE
Second Line	:	SUTE 4(D)
City	:	PALATKA
State	:	FL
Zip	:	32177-3844
Country	:	US
Telephone Number	:	386-329-3939
Fax Number	:	386-329-8990

Provider Business Practice Location Address
First Line	:	6100 SAINT JOHNS AVE
Second Line	:	SUITE 4(D)
City	:	PALATKA
State	:	FL
Zip	:	32177-3844
Country	:	US
Telephone Number	:	386-329-3939
Fax Number	:	386-329-8990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	03/26/2012

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