Provider Demographics
NPI:1467772145
Name:HEART OF FLORIDA DIABETES AND ENDOCRINE LLC
Entity Type:Organization
Organization Name:HEART OF FLORIDA DIABETES AND ENDOCRINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-DABAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-419-7509
Mailing Address - Street 1:171 WEBB DR
Mailing Address - Street 2:STE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3944
Mailing Address - Country:US
Mailing Address - Phone:863-419-7509
Mailing Address - Fax:863-419-7824
Practice Address - Street 1:171 WEBB DR
Practice Address - Street 2:STE 2
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3944
Practice Address - Country:US
Practice Address - Phone:863-419-7509
Practice Address - Fax:863-419-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty