Provider Demographics
NPI:1538185590
Name:MALIK, KHIZAR M (MD)
Entity type:Individual
Prefix:DR
First Name:KHIZAR
Middle Name:M
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32 W GORE ST
Mailing Address - Street 2:FL 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1134
Mailing Address - Country:US
Mailing Address - Phone:407-352-5434
Mailing Address - Fax:407-345-9765
Practice Address - Street 1:32 W GORE ST
Practice Address - Street 2:FL 3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1134
Practice Address - Country:US
Practice Address - Phone:407-352-5434
Practice Address - Fax:407-345-9765
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME881502084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104149100Medicaid
FL81149AMedicare ID - Type Unspecified