Provider Demographics
NPI:1972553253
Name:MALIK, VINOD K (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:K
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1671 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-274-2977
Mailing Address - Fax:386-274-2966
Practice Address - Street 1:1671 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-274-2977
Practice Address - Fax:386-274-2966
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0069567207L00000X, 208VP0000X
FLME69567208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251816300Medicaid
FLG10663Medicare UPIN
FL251816300Medicaid