Provider Demographics
NPI:1144249335
Name:RAZIA B MALIK PA
Entity type:Organization
Organization Name:RAZIA B MALIK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANJEEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUJAAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-877-8292
Mailing Address - Street 1:PO BOX 150250
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32715-0250
Mailing Address - Country:US
Mailing Address - Phone:407-877-8292
Mailing Address - Fax:407-877-8685
Practice Address - Street 1:710 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7640
Practice Address - Country:US
Practice Address - Phone:407-877-8292
Practice Address - Fax:407-877-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47609AOtherMEDIARE PART B