Healthcare Provider Details

I. General information

NPI: 1114855962
Provider Name (Legal Business Name): IMAAD UDDIN MALLICK M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD SUITE 50
DETROIT MI
48236
US

IV. Provider business mailing address

20812 LITTLESTONE RD, APARTMENT 1
HARPER WOODS MI
48225
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7774
  • Fax:
Mailing address:
  • Phone: 905-301-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: