Individual
DR. SHAHLA MALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
379 DIXMYTH AVE, STE N, CINCINNATI, OH 45220-2475
(513) 246-7000
(513) 246-7590
Mailing address
4685 FOREST AVE, SUITE C, CINCINNATI, OH 45212-3397
(513) 853-4721
(513) 852-8525
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
35070787
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2212028
—
OH
01
—
P00340572
MEDICARE RR
OH
Enumeration date
05/31/2006
Last updated
06/26/2014
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