Provider Demographics
NPI:1972668630
Name:MALIK, PARVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:PARVEEN
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-0703
Mailing Address - Country:US
Mailing Address - Phone:989-220-6773
Mailing Address - Fax:
Practice Address - Street 1:11268 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6152
Practice Address - Country:US
Practice Address - Phone:407-465-1996
Practice Address - Fax:407-465-1997
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065126208D00000X
FLME97637208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010090049-2OtherBLUECROSSBLUESHIELD
MI010090049-2OtherBLUECROSSBLUESHIELD
MI0M05390Medicare ID - Type Unspecified