MEDICARE: AMIR A MALIK MD PA

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	207RN0300X	Nephrology Physician	ME50791	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	:	1922260470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIR A MALIK MD PA

Provider Business Mailing Address
First Line	:	PO BOX 1779
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32085-1779
Country	:	US
Telephone Number	:	904-829-8300
Fax Number	:	904-829-8310

Provider Business Practice Location Address
First Line	:	264 PALM COAST PKWY NE
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8217
Country	:	US
Telephone Number	:	386-446-1940
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMIR A MALIK
Credential	:	MD
Telephone Number	:	904-829-8300

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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