Provider Demographics
NPI:1033275615
Name:MALLICK, NAVEED K (MD)
Entity type:Individual
Prefix:DR
First Name:NAVEED
Middle Name:K
Last Name:MALLICK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 E 56TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1952
Mailing Address - Country:US
Mailing Address - Phone:773-321-0200
Mailing Address - Fax:877-863-7393
Practice Address - Street 1:1642 E 56TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1952
Practice Address - Country:US
Practice Address - Phone:773-321-0200
Practice Address - Fax:877-863-7393
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101915207R00000X
IL036101915207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL13336472851OtherBCBS GROUP NUMBER
ILIL3203OtherPTAN GROUP
IL036101915Medicaid
IL1336472851OtherNPI GROUP NUMBER
ILDS3487OtherRAILROAD MEDICARE PTAN
IL3203001OtherPTAN INDIVIDUAL
IL1600527OtherBCBS INDIVIDUAL NUMBER
IL036101915Medicaid