| Mohammad Mallick, Md, Llc | |
|
1525 Liberty Ct Brookfield WI 53045-5327 | |
| (262) 821-5525 | |
| (262) 821-5525 |
| Full Name | Mohammad Mallick, Md, Llc |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1525 Liberty Ct, Brookfield, Wisconsin |
| Authorized Official Name and Position | Mohammad Sultan Mallick (PRESIDENT) |
| Authorized Official Contact | 2828215525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mohammad Mallick, Md, Llc 1525 Liberty Ct Brookfield WI 53045-5327 Ph: (262) 821-5525 | Mohammad Mallick, Md, Llc 1525 Liberty Ct Brookfield WI 53045-5327 Ph: (262) 821-5525 |
| NPI Number | 1629221502 |
|---|---|
| Provider Enumeration Date | 10/23/2008 |
| Last Update Date | 10/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629221502 | NPI | - | NPPES |
| 31466300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 22719 (Wisconsin) | Primary |
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