Healthcare Provider Details

I. General information

NPI: 1457666026
Provider Name (Legal Business Name): ORWAH AL-KHALILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 W THUNDERBIRD RD
PEORIA AZ
85381-5025
US

IV. Provider business mailing address

6818 W THUNDERBIRD RD
PEORIA AZ
85381-5025
US

V. Phone/Fax

Practice location:
  • Phone: 623-566-3550
  • Fax: 623-566-3573
Mailing address:
  • Phone: 623-566-3550
  • Fax: 623-566-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number62879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: