Individual
ALI SALIM ABOOD ALSHATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 N DYSART RD STE G127, AVONDALE, AZ 85392-1011
(623) 322-0323
(623) 322-0757
Mailing address
3400 N DYSART RD STE G127, AVONDALE, AZ 85392-1011
(623) 322-0323
(602) 603-2263
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01093721A
IN
207RG0100X
Gastroenterology Physician
01093721A
IN
207RG0100X
Gastroenterology Physician
321235
NY
207RG0100X
Gastroenterology Physician
Primary
73145
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103127810
ANTHEM PTAN
IN
05
—
300090503
—
IN
Enumeration date
04/04/2017
Last updated
08/22/2025
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