Healthcare Provider Details

I. General information

NPI: 1629609664
Provider Name (Legal Business Name): ALLISON NICOLE MALICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # 4076
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

V. Phone/Fax

Practice location:
  • Phone: 773-795-1824
  • Fax: 773-702-2182
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1002X
TaxonomyPhysician Nutrition Specialist (Internal Medicine)
License Number125087219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: