Provider Demographics
NPI:1831390111
Name:SALLOUM, ANAN
Entity type:Individual
Prefix:DR
First Name:ANAN
Middle Name:
Last Name:SALLOUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 KLINGENSMITH RD
Mailing Address - Street 2:# 74 B
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0261
Mailing Address - Country:US
Mailing Address - Phone:314-410-3230
Mailing Address - Fax:
Practice Address - Street 1:1920 KLINGENSMITH RD
Practice Address - Street 2:# 74 B
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0261
Practice Address - Country:US
Practice Address - Phone:314-410-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081045207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease