Individual
MOHAMMAD S MALLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1525 LIBERTY CT, BROOKFIELD, WI 53045-5327
(262) 646-6280
Mailing address
1525 LIBERTY CT, BROOKFIELD, WI 53045-5327
(262) 646-6280
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
27719
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31466300
—
WI
Enumeration date
07/09/2006
Last updated
10/17/2008
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