Provider Demographics
NPI:1932197076
Name:AJIT, MALVINDER S (MD)
Entity type:Individual
Prefix:
First Name:MALVINDER
Middle Name:S
Last Name:AJIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3209 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5651
Mailing Address - Country:US
Mailing Address - Phone:850-227-8450
Mailing Address - Fax:850-271-9659
Practice Address - Street 1:3209 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5651
Practice Address - Country:US
Practice Address - Phone:850-227-8450
Practice Address - Fax:850-271-9659
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME76922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44493WMedicare ID - Type Unspecified
FLG85574Medicare UPIN