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Organization
MOHAMMAD S MALLICK MD LLC
Active
Organization
MOHAMMAD S MALLICK MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY K DUCHIN (MANAGER)
(262) 646-6280
Entity
Organization
Contact information
Practice address
1525 LIBERTY CT, BROOKFIELD, WI 53045-5327
(262) 646-6280
Mailing address
1525 LIBERTY CT, BROOKFIELD, WI 53045-5327
(262) 646-6280
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
27719
WI
Other
Enumeration date
08/14/2007
Last updated
08/14/2007
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