Individual
DR. MEHER S MALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10004 KENNERLY RD STE 361B, SAINT LOUIS, MO 63128-2141
(314) 843-3449
(314) 843-8762
Mailing address
PO BOX 840132, KANSAS CITY, MO 64184-0132
(314) 843-3449
(314) 843-8762
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2001009904
MO
207RN0300X
Nephrology Physician
Primary
2001009904
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000013440
MEDICARE PTAN
—
05
—
036099093
—
IL
01
—
390007770
RAILROAD MEDICARE
—
05
—
6317901
—
IL
Enumeration date
02/15/2006
Last updated
04/18/2025
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