Mohammad S Mallick, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

27719 Issued in WI

Practice address

1525 Liberty CT
Brookfield, WI 53045-5327

Phone

(262) 646-6280

NPI assigned

Jul 9, 2006

Last updated

Oct 17, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 WI

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Waukesha County

  • Case Management Agency
  • Waukesha, WI
  • NPI 1740403146
  Medicare reassignment NPD
• Mohammad Mallick, MD, LLC

  • Psychiatric Hospital Unit
  • Brookfield, WI
  • NPI 1629221502
  Authorized official Same address or phone
• Waukesha County

  • Psychiatric Hospital
  • Waukesha, WI
  • NPI 1407988892
  NPD
• Waukesha County

  • Mental Illness Community Based Residential Treatment Facility
  • Waukesha, WI
  • NPI 1477314854
  NPD
• Milwaukee Mental Health Associates, Inc

  • Community/Behavioral Health Agency
  • Milwaukee, WI
  • NPI 1730337338
  NPD (past)
• Milwaukee Mental Health Associates, Inc.

  • Community/Behavioral Health Agency
  • Milwaukee, WI
  • NPI 1154594406
  NPD (past)

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224201600000",
    "number": "1689607798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 LIBERTY CT",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455327",
            "telephone_number": "262-646-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 LIBERTY CT",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455327",
            "telephone_number": "262-646-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLICK",
        "first_name": "MOHAMMAD",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2008-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "27719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31466300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn Marjorie Majerowski, M.D.
• Andrew Makela
• Laurel L Makovsky, MS CCC SLP
• Deborah Ann Makowski, SPEECH PATHOLOGIST
• Jennifer Mallas, OTR
• Keri Mallon
• Mary Ellen Malloy, OT
• Angela Marie Malm, OTR
• Maria Manby, M.S. SLP/CCC
• Ann Carol Maney

• Psychiatry Physician in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; 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.