Organization
MOHAMMAD MALLICK M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD S MALLICK M.D. (OWNER)
(414) 226-4046
Entity
Organization
Contact information
Practice address
1501 AIRPORT RD, WAUKESHA, WI 53188-2461
(262) 548-7950
Mailing address
500 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7954
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
07/30/2006
Last updated
12/01/2011
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