Provider Demographics
NPI:1194833392
Name:HIBA, MUHAMMED-RODWAN ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMED-RODWAN
Middle Name:ALI
Last Name:HIBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M. RODWAN
Other - Middle Name:
Other - Last Name:HIBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12102 CORTEZ BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5514
Mailing Address - Country:US
Mailing Address - Phone:352-597-4000
Mailing Address - Fax:352-597-0550
Practice Address - Street 1:12102 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5514
Practice Address - Country:US
Practice Address - Phone:352-597-4000
Practice Address - Fax:352-597-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 69833207R00000X, 207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2579162-00Medicaid
29-87121OtherUNITED HEALTH CARE
7130082OtherAETNA
1003105OtherHUMANA
100016261OtherMEDICARE RAILROAD
2593473OtherGHI
21196012157-01OtherBEECH STREET
FL49489OtherBLUE CROSS BLUE SHIELD
21196012157-01OtherBEECH STREET
29-87121OtherUNITED HEALTH CARE