Provider Demographics
NPI:1639952625
Name:BATARSEH, ISSA (MD)
Entity type:Individual
Prefix:
First Name:ISSA
Middle Name:
Last Name:BATARSEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E AJO WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6204
Mailing Address - Country:US
Mailing Address - Phone:520-874-2778
Mailing Address - Fax:520-874-3456
Practice Address - Street 1:2800 E AJO WAY STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6204
Practice Address - Country:US
Practice Address - Phone:520-874-2778
Practice Address - Fax:520-874-3456
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR80162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine