Organization
SAMIR MULLICK MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR MULLICK MD (OWNER)
(414) 873-3440
Entity
Organization
Contact information
Practice address
4267 W FOND DU LAC AVE, MILWAUKEE, WI 53216-3527
(414) 873-3440
Mailing address
4267 W FOND DU LAC AVE, MILWAUKEE, WI 53216-3527
(414) 873-3440
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38382
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21267700
—
WI
Enumeration date
05/18/2006
Last updated
08/22/2020
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