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Individual

ALI FAROUK MALLAT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6000 W CREEK RD, SUITE 10, INDEPENDENCE, OH 44131-2182
(216) 986-1256
Mailing address
6000 W CREEK RD, SUITE 10, INDEPENDENCE, OH 44131-2182
(216) 986-1256

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
129879
OH
208600000X
Surgery Physician
4301089640
MI
2086S0102X
Surgical Critical Care Physician
129879
OH
2086S0102X
Surgical Critical Care Physician
4301089640
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301089640
MI

Other

Enumeration date
05/02/2007
Last updated
03/25/2017
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