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General NPI Number Information
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NPI Number | 1235182221
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Entity Type | Organization
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Legal Business Name | SAMIR MULLICK MD SC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4267 W FOND DU LAC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3527
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Country | US
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Telephone | 414-873-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 4267 W FOND DU LAC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3527
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Country | US
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Telephone | 414-873-3440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMIR MULLICK
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Credential | MD
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Telephone | 414-873-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 38382
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License Number State | WI
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