Individual
BASSAM K MECHLEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 S 13TH AVE, LAUREL, MS 39440-4345
(601) 425-5544
(601) 425-5525
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 425-5544
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
19531
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02182072
—
MS
01
—
7837897
AETNA
MS
01
—
P00417389
RAILROAD MEDICARE
MS
Enumeration date
05/07/2007
Last updated
08/23/2016
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