Srour Mallah, Husam

Srour Mallah, Husam is an individual health care provider with primary practice located at 5757 W Thunderbird Rd Ste W310 , Glendale AZ 85306-4644. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Pediatric Gastroenterology is his primary health care specialty. Srour Mallah, Husam can be contacted via phone (602) 865-4011.

Contact Information

Primary practice address
5757 W Thunderbird Rd Ste W310 Glendale AZ 85306-4644
Phone: (602) 865-4011
Fax: (602) 865-4250
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 01067525A Indiana
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X 01067525A Indiana

Profile Details

NPI number 1912048703
LBN Legal business name Srour Mallah, Husam
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 12th, 2007
Last updated Sep 29th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912048703 NPPES
Indiana Other 000000664359 ANTHEM
Indiana MEDICAID 200987180 ANTHEM

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