Provider Demographics
NPI:1093789034
Name:MALLICK, MEHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHER
Middle Name:S
Last Name:MALLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 840132
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-0132
Mailing Address - Country:US
Mailing Address - Phone:314-843-3449
Mailing Address - Fax:314-843-8762
Practice Address - Street 1:10004 KENNERLY RD STE 361B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-843-3449
Practice Address - Fax:314-843-8762
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001009904174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099093Medicaid
390007770OtherRAILROAD MEDICARE
IL6317901Medicaid
000013440OtherMEDICARE PTAN
MOF90127Medicare UPIN