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
036.099093
IL
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
05/29/2026
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