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Individual

DR. CHARLES MILES MALISKA III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2402 FRIST BLVD STE 204, FORT PIERCE, FL 34950-4838
(772) 462-3939
Mailing address
2402 FRIST BLVD STE 204, FORT PIERCE, FL 34950-4838
(772) 462-3939

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
27745
OK
208600000X
Surgery Physician
303595
NY
208600000X
Surgery Physician
A99319
CA
208600000X
Surgery Physician
R2163
TX
2086S0102X
Surgical Critical Care Physician
27745
OK
2086S0102X
Surgical Critical Care Physician
303595
NY
2086S0102X
Surgical Critical Care Physician
A99319
CA
2086S0102X
Surgical Critical Care Physician
Primary
ME150816
FL
2086S0102X
Surgical Critical Care Physician
R2163
TX
2086S0127X
Trauma Surgery Physician
27745
OK
2086S0127X
Trauma Surgery Physician
303595
NY
2086S0127X
Trauma Surgery Physician
A99319
CA
2086S0127X
Trauma Surgery Physician
R2163
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200330440A
OK
Enumeration date
01/26/2007
Last updated
06/07/2021
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