Provider Demographics
NPI:1336472851
Name:NAVEED K. MALLICK MD PC
Entity Type:Organization
Organization Name:NAVEED K. MALLICK MD PC
Other - Org Name:CHICAGO CENTER FOR ADULT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:K
Authorized Official - Last Name:MALLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-321-0200
Mailing Address - Street 1:1642 E 56TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1952
Mailing Address - Country:US
Mailing Address - Phone:773-321-0200
Mailing Address - Fax:877-863-7393
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2315
Practice Address - Country:US
Practice Address - Phone:810-275-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101915207R00000X, 207RS0012X
IL036.101915261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH44749Medicare UPIN