Carolyn T Mallillin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

45207 Issued in WI

Practice address

1900 Bluegrass Ave Ste 300
Louisville, KY 40215-1183

Phone

(502) 361-1222

NPI assigned

Sep 7, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1194719971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 CHINA BLUE LN",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637013800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 BLUEGRASS AVE STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151183",
            "telephone_number": "502-361-1222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 N Westwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639013318",
            "country_code": "US",
            "telephone_number": "573-686-4151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLILLIN",
        "first_name": "CAROLYN",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-07",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "45207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34336500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mauri G Malka, LCSW
• Arthur Lalit/Laxman Malkani, M.D.
• Azzam Malkawi
• Dhiraj Mallela, BDS
• Miranda Mallicoat
• Mary Nan Mallory, M.D.
• Sharry D Mallory
• Madison Jean Malloy, LPCA
• Meghan Ann Malloy, MD
• Michelle Marie Malone Purvis

• Family Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.