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General NPI Number Information
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NPI Number | 1851202873
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Entity Type | Individual
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Provider Name | MAHMOUD MALLAH
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Gender | Male
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 411 S LAFAYETTE ST
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City | DEARBORN
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State | MI
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Zip | 48124-1383
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Country | US
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Telephone | 313-899-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 14126 WOODWARD AVE
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-2995
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Country | US
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Telephone |
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Fax |
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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