Malik M Willis, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

242624 Issued in NY

Practice address

234 E 149TH St
Bronx, NY 10451-5504

Phone

(718) 579-6010

NPI assigned

Apr 18, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwillis13459@mhsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Inphynet South Broward LLC

  • Emergency Medicine Physician
  • Hollywood, FL
  • NPI 1871521880
  Medicare reassignment NPD
• Phoenix Emergency Medicine of Broward LLC

  • Emergency Medicine Physician
  • Coral Springs, FL
  • NPI 1871542969
  Medicare reassignment NPD
• Phoenix Emergency Medicine of Broward LLC

  • Emergency Medicine Physician
  • Deerfield Beach, FL
  • NPI 1407805591
  NPD
• FL-I Medical Services, LLC

  • Physician Assistant
  • Margate, FL
  • NPI 1780959643
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1871719567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 BUSSING AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104662029",
            "telephone_number": "718-547-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515504",
            "telephone_number": "718-579-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MALIK",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "242624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwillis13459@MHSDIRECT.NET",
            "affiliation": "N",
            "address_1": "703 N Flamingo Rd",
            "city": "Pembroke Pines",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330281006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aaliyah Willis, LMSW
• Adrienne Christina Willis, LMT
• Crystal Willis
• Frederick Willis
• Israel Willis
• Debra Willner, PHARMD
• Glenda Willock
• Braxton Willoughby, OTR/L
• Melissa Willow, LMSW
• Joan Wills

• Emergency Medicine Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.