Provider Demographics
NPI:1538692926
Name:ALSHATI, ALI S (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:S
Last Name:ALSHATI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W THUNDERBIRD RD STE W212
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-5607
Mailing Address - Country:US
Mailing Address - Phone:602-603-2275
Mailing Address - Fax:602-603-2263
Practice Address - Street 1:5757 W THUNDERBIRD RD STE W212
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-5607
Practice Address - Country:US
Practice Address - Phone:602-603-2275
Practice Address - Fax:602-603-2263
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01093721A207R00000X, 207RG0100X
NY321235207RG0100X
390200000X
AZ73145207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300090503Medicaid
IN1103127810OtherANTHEM PTAN