Provider Demographics
NPI:1346362910
Name:FADI A HABIB MD FRCSC LTD
Entity Type:Organization
Organization Name:FADI A HABIB MD FRCSC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-725-0760
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-725-0760
Mailing Address - Fax:773-725-3499
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-725-0760
Practice Address - Fax:773-725-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1607486OtherBCBS PROVIDER NUMBER
IL1607486OtherBCBS PROVIDER NUMBER
ILK08085Medicare ID - Type UnspecifiedPOVIDER
IL209463Medicare ID - Type UnspecifiedGROUP