MEDICARE: DR. IMRAN MUSHTAQ MALIK M.D.

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	207Q00000X	Family Medicine Physician	4301090215	MI
2	207Q00000X	Family Medicine Physician	ME107296	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760651285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMRAN MUSHTAQ MALIK M.D.

Provider Business Mailing Address
First Line	:	8515 S US HIGHWAY 1
Second Line	:	SUITE 3
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-380-4042
Fax Number	:	772-380-4043

Provider Business Practice Location Address
First Line	:	8515 S US HIGHWAY 1
Second Line	:	SUITE 3
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-380-4042
Fax Number	:	772-380-4043

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	11/15/2011

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