Individual
EDWARD G GHATTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
26900 N LAKE PLEASANT PKWY # 200, PEORIA, AZ 85383-1394
(623) 561-3000
(623) 561-3009
Mailing address
26900 N LAKE PLEASANT PKWY # 200, PEORIA, AZ 85383-1394
(623) 561-3000
(623) 561-3009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
005164
AZ
207Q00000X
Family Medicine Physician
5101011159
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080093523
METRAHEALTH
MI
01
—
080D410020
BLUE CROSS BLUE SHIELD
MI
01
—
0852524385
HEALTH PLUS
MI
01
—
204373
HEALTH ADVANTAGE NETWORK
MI
01
—
2341129003
CIGNA
MI
05
—
3327505
—
MI
05
—
425169
—
AZ
01
—
5895095
AETNA
MI
01
—
C2472
MCARE
MI
01
—
F78381
HEALTH ALLIANCE PLAN
MI
Enumeration date
10/27/2005
Last updated
01/20/2020
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