Organization
MOHAMMAD MALLICK, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD SULTAN MALLICK M.D. (PRESIDENT)
(282) 821-5525
Entity
Organization
Contact information
Practice address
1525 LIBERTY CT, BROOKFIELD, WI 53045-5327
(262) 821-5525
(262) 821-5525
Mailing address
1525 LIBERTY CT, BROOKFIELD, WI 53045-5327
(262) 821-5525
(262) 821-5525
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
22719
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31466300
—
WI
Enumeration date
10/23/2008
Last updated
10/23/2008
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