Healthcare Provider Details

I. General information

NPI: 1992445373
Provider Name (Legal Business Name): IHSAN AL BAYATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W THOMAS RD
PHOENIX AZ
85037-3332
US

IV. Provider business mailing address

3201 SPRINGHILL DR STE 100
NORTH LITTLE ROCK AR
72117-2905
US

V. Phone/Fax

Practice location:
  • Phone: 623-327-7313
  • Fax:
Mailing address:
  • Phone: 501-955-4530
  • Fax: 501-955-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number77281
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: