Doctor Name: | NADIR MALLICK |
NPI Number: | 1386930428 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301099249 |
Business Practice Address: | 20180 S Lagrange Rd Frankfort, IL - 604233153 |
Business Phone Number: | 8154642010 |
Business Fax Number: | 8154642181 |
Mailing Address: | 1040 Sierra Dr, Suite 400 GREENWOOD |
State: | IN |
Postal Code: | 461437241 |
Phone Number: | 3175284800 |
Fax Number: | 3178651479 |
NPI Enumeration Date: | 06/28/2011 |
NPI Last Update Date: | 04/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301099249 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |