Provider Demographics
NPI:1114625720
Name:MUALLEM, SARI
Entity Type:Individual
Prefix:
First Name:SARI
Middle Name:
Last Name:MUALLEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 GLENCOE HILLS DR APT 4
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1043
Mailing Address - Country:US
Mailing Address - Phone:630-217-0668
Mailing Address - Fax:
Practice Address - Street 1:2133 GLENCOE HILLS DR APT 4
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1043
Practice Address - Country:US
Practice Address - Phone:630-217-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician