Provider Demographics
NPI:1285969295
Name:AMIR A MALIK MD PA
Entity type:Organization
Organization Name:AMIR A MALIK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-829-8300
Mailing Address - Street 1:PO BOX 1779
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-1779
Mailing Address - Country:US
Mailing Address - Phone:386-312-0556
Mailing Address - Fax:386-326-3971
Practice Address - Street 1:199 S US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-6071
Practice Address - Country:US
Practice Address - Phone:386-312-0556
Practice Address - Fax:386-326-3971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMIR A MALIK MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50791207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39898OtherBCBS