HUSAM SROUR MALLAH MD NPI 1912048703

NPI Information

NPI: 1912048703
Provider Name: HUSAM SROUR MALLAH, MD
Classification: Pediatrics - 2080P0206X
Entity Type: Individual

Specialization: Pediatric Gastroenterology

PECOS Registration: Yes

Address:
5757 W THUNDERBIRD RD STE W310
GLENDALE, AZ
ZIP 85306
Phone: (602) 865-4011
Get Directions

Husam Srour Mallah, MD is a pediatric gastroenterology pediatrics in Glendale, AZ. The provider is a pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. Husam Srour Mallah, MD NPI is 1912048703. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5757 W THUNDERBIRD RD STE W310
GLENDALE, AZ
ZIP 85306-644
Phone: (602) 865-4011
Fax: (602) 865-4250

The NPI 1912048703 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/12/2007 and was last updated on 9/29/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		01067525A	INDIANA	No
2	2080P0206X	Pediatrics	Pediatric Gastroenterology	01067525A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000664359	OTHER	INDIANA	ANTHEM
2	200987180	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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