Provider Demographics
NPI:1720090558
Name:MALHIS, SAFOUH (MD)
Entity Type:Individual
Prefix:DR
First Name:SAFOUH
Middle Name:
Last Name:MALHIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:PMB 45
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-5005
Mailing Address - Country:US
Mailing Address - Phone:760-659-0098
Mailing Address - Fax:
Practice Address - Street 1:100 SUSAN DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2826
Practice Address - Country:US
Practice Address - Phone:814-255-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-062912-L207R00000X
CAC54927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017122470003Medicaid
PA290013637OtherRAILROAD MEDICARE
PA999440OtherBLUE SHIELD/HIGHMARK
PA999440OtherBLUE SHIELD/HIGHMARK
PA290013637OtherRAILROAD MEDICARE