Organization
INDIVIDUALIZED MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARISA MALYKH MD (PRACTICE OWNER/PHYSICIAN)
(386) 329-3939
Entity
Organization
Contact information
Practice address
6100 SAINT JOHNS AVE, SUITE 4(D), PALATKA, FL 32177-3844
(386) 329-3939
(386) 329-8990
Mailing address
PO BOX 100, ELKTON, FL 32033-0100
(386) 329-3939
(386) 329-8990
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
03/19/2011
Last updated
03/26/2012
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