Provider Demographics
NPI:1134463474
Name:HABASH MD
Entity Type:Organization
Organization Name:HABASH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HABASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-484-0222
Mailing Address - Street 1:PO BOX 190922
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-0922
Mailing Address - Country:US
Mailing Address - Phone:817-484-0222
Mailing Address - Fax:
Practice Address - Street 1:1100 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6357
Practice Address - Country:US
Practice Address - Phone:817-484-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1459208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty