Provider Demographics
NPI:1104191485
Name:MALLICK, ISMAIL HAMEED (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:HAMEED
Last Name:MALLICK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 SEVILLE DR
Mailing Address - Street 2:APT 201
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7594
Mailing Address - Country:US
Mailing Address - Phone:216-854-3447
Mailing Address - Fax:
Practice Address - Street 1:26300 SEVILLE DR
Practice Address - Street 2:APT 201
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7594
Practice Address - Country:US
Practice Address - Phone:216-854-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program