Provider Demographics
NPI:1043307465
Name:MUHIB ALATTAR, MD, SC
Entity Type:Organization
Organization Name:MUHIB ALATTAR, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHIB
Authorized Official - Middle Name:
Authorized Official - Last Name:ALATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-905-0000
Mailing Address - Street 1:PO BOX 20490
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0490
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-985-0468
Practice Address - Street 1:8404 E SHEA BLVD
Practice Address - Street 2:SUITE 100B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6658
Practice Address - Country:US
Practice Address - Phone:480-905-0000
Practice Address - Fax:480-905-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088959Medicaid
ILG39161Medicare UPIN
IL208756Medicare ID - Type UnspecifiedMEDICARE#