Provider Demographics
NPI:1194901249
Name:MALEK HANANO MD PLLC
Entity type:Organization
Organization Name:MALEK HANANO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALEK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-937-5356
Mailing Address - Street 1:5694 WINDHOVER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7935
Mailing Address - Country:US
Mailing Address - Phone:407-363-3449
Mailing Address - Fax:407-363-3450
Practice Address - Street 1:5694 WINDHOVER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7935
Practice Address - Country:US
Practice Address - Phone:407-363-3449
Practice Address - Fax:407-363-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28033208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067007300Medicaid
FL53485Medicare PIN
FL067007300Medicaid