Healthcare Provider Details

I. General information

NPI: 1366247272
Provider Name (Legal Business Name): MALLORY HAPP MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

IV. Provider business mailing address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone: 312-503-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125087494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: