Provider Demographics
NPI:1508867540
Name:HABIB, MAGED (MD)
Entity Type:Individual
Prefix:
First Name:MAGED
Middle Name:
Last Name:HABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S CONGRESS AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:561-742-1944
Mailing Address - Fax:561-742-0525
Practice Address - Street 1:2300 S CONGRESS AVE
Practice Address - Street 2:STE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-742-1944
Practice Address - Fax:561-742-0525
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLME77394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257361000Medicaid
FLG99899Medicare UPIN
FL257361000Medicaid