Healthcare Provider Details

I. General information

NPI: 1689980088
Provider Name (Legal Business Name): THE ARIZONA CENTER FOR COLON AND RECTAL DISEASES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 W MEEKER BLVD 201
SUN CITY WEST AZ
85375-5286
US

IV. Provider business mailing address

14420 W MEEKER BLVD 201
SUN CITY WEST AZ
85375-5286
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-4600
  • Fax: 623-544-4725
Mailing address:
  • Phone: 623-544-4600
  • Fax: 623-544-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number40932
License Number StateAZ

VIII. Authorized Official

Name: DR. AHMED SHALABI
Title or Position: MEMBER
Credential: M.D.
Phone: 410-591-7649