Healthcare Provider Details

I. General information

NPI: 1740806041
Provider Name (Legal Business Name): NABEEL MALLICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

5156 PECAN DR
YPSILANTI MI
48197-6818
US

V. Phone/Fax

Practice location:
  • Phone: 800-772-7769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340170
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: