MEDICARE: DR. SALEHA MALLICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036155638	IL

General Provider Information

NPI Number	:	1427542307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALEHA MALLICK MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:	847-733-5315

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-1027
Fax Number	:	847-733-5108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	04/23/2026

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