Provider Demographics
NPI:1477046548
Name:SALEEM, MOATAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOATAZ
Middle Name:
Last Name:SALEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOATAZ
Other - Middle Name:ABDULLAH SALEEM
Other - Last Name:AL-BAYATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 W THOMAS RD STE 900A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4223
Mailing Address - Country:US
Mailing Address - Phone:602-406-5556
Mailing Address - Fax:
Practice Address - Street 1:7501 E MCDOWELL RD APT 3165
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3574
Practice Address - Country:US
Practice Address - Phone:718-785-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63166174400000X, 207RH0002X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ164160Medicaid