Healthcare Provider Details

I. General information

NPI: 1477046548
Provider Name (Legal Business Name): MOATAZ SALEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOATAZ ABDULLAH SALEEM AL-BAYATI MD

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 E MCDOWELL RD APT 3165
SCOTTSDALE AZ
85257-3574
US

IV. Provider business mailing address

500 W THOMAS RD STE 900A
PHOENIX AZ
85013-4223
US

V. Phone/Fax

Practice location:
  • Phone: 718-785-7883
  • Fax:
Mailing address:
  • Phone: 602-406-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number63166
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number63166
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: