Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Carolyn T Mallillin, MD

Individual provider Family Medicine Physician · NPI 1194719971

Carolyn T Mallillin, MD is a Family Medicine Physician in Louisville, Kentucky. Works from 2 locations. Licensed in Wisconsin.

Licensed in
WI
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1900 Bluegrass Ave Ste 300
Louisville, KY 40215-1183
Phone: (502) 361-1222
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 — (573) 686-4151

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 45207 (WI)

Record details

NPI number1194719971
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 7, 2005
Last updated in NPPESJanuary 14, 2021
Certification dateJanuary 14, 2021

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