Provider Demographics
NPI:1437197860
Name:HABASHY, MICHEL S
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:S
Last Name:HABASHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ROLLING ACRES RD
Mailing Address - Street 2:UNIT 208
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5029
Mailing Address - Country:US
Mailing Address - Phone:352-259-9970
Mailing Address - Fax:352-259-9971
Practice Address - Street 1:918 ROLLING ACRES RD
Practice Address - Street 2:SUITE #6
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-259-9970
Practice Address - Fax:352-259-9971
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13198OtherBCBSFL
FL13198OtherBCBSFL
FLK3619Medicare ID - Type Unspecified