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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912048703 | NPPES |
| Indiana | Other | 000000664359 | ANTHEM |
| Indiana | MEDICAID | 200987180 | ANTHEM |
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