Provider Demographics
NPI:1528214129
Name:ISMAIL, SHUROUK I (MD)
Entity Type:Individual
Prefix:
First Name:SHUROUK
Middle Name:I
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18564 US HIGHWAY 18
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2312
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:888-847-5757
Practice Address - Street 1:18522 US HIGHWAY 18
Practice Address - Street 2:SUITE 208
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2321
Practice Address - Country:US
Practice Address - Phone:760-242-9262
Practice Address - Fax:760-242-9264
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036121559208000000X
CAC137856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics