Provider Demographics
NPI:1124000104
Name:HABIB, ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:
Last Name:HABIB
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 1:2120 MADISON AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4744
Mailing Address - Country:US
Mailing Address - Phone:618-876-7515
Mailing Address - Fax:618-876-7596
Practice Address - Street 1:755 S NEW BALLAS RD
Practice Address - Street 2:STE 160
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8703
Practice Address - Country:US
Practice Address - Phone:314-989-0542
Practice Address - Fax:618-876-7596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1142592084P0800X
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G16509Medicare UPIN
ILL82157Medicare ID - Type Unspecified