MEDICARE: DR. NAVEED K MALLICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-101915	IL
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	036101915	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DS3487	OTHER	IL	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13336472851	OTHER	IL	BCBS GROUP NUMBER
2	IL3203	OTHER	IL	PTAN GROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1336472851	OTHER	IL	NPI GROUP NUMBER
6	3203001	OTHER	IL	PTAN INDIVIDUAL
7	1600527	OTHER	IL	BCBS INDIVIDUAL NUMBER

General Provider Information

NPI Number	:	1033275615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAVEED K MALLICK MD

Provider Business Mailing Address
First Line	:	1642 E 56TH ST
Second Line	:	SUITE 107
City	:	CHICAGO
State	:	IL
Zip	:	60637-1952
Country	:	US
Telephone Number	:	773-321-0200
Fax Number	:	877-863-7393

Provider Business Practice Location Address
First Line	:	1642 E 56TH ST
Second Line	:	SUITE 107
City	:	CHICAGO
State	:	IL
Zip	:	60637-1952
Country	:	US
Telephone Number	:	773-321-0200
Fax Number	:	877-863-7393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	03/13/2025

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Directions to “ DR. NAVEED K MALLICK MD” Practice Location

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