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General NPI Number Information
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NPI Number | 1205977634
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Entity Type | Individual
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Provider Name | BASSAM N. SHUKRALLAH MD
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 9601 BAPTIST HEALTH DR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6342
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Country | US
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Telephone | 501-223-2860
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Fax | 501-223-2258
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Provider Business Mailing Address
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Address Line | 11001 EXECUTIVE CENTER DR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4393
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Country | US
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Telephone | 501-812-7800
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Fax | 501-812-7777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | E-16164
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License Number State | AR
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