MEDICARE: DR. ANDREW MALOZSAK

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN26140	FL

General Provider Information

NPI Number	:	1164287843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MALOZSAK

Provider Business Mailing Address
First Line	:	596 SE VILLANDRY WAY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-6683
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 COLORADO AVE
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2106
Country	:	US
Telephone Number	:	772-287-3999
Fax Number	:

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

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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Directions to “ DR. ANDREW MALOZSAK ” Practice Location

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