Basic Information
| Provider Information | |||||||||
| NPI: | 1689237695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATALLAH | ||||||||
| FirstName: | AHMAD | ||||||||
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| Credential: | MD, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 E MCDOWELL RD | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028392266 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6644 E BAYWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803212000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 65596 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.