Provider Demographics
NPI:1558526285
Name:HABIB, AMMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMMAR
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 1:9119 W 74TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2268
Mailing Address - Country:US
Mailing Address - Phone:913-632-9400
Mailing Address - Fax:913-632-9444
Practice Address - Street 1:9119 W 74TH ST STE 350
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2268
Practice Address - Country:US
Practice Address - Phone:913-632-9400
Practice Address - Fax:913-632-9444
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52236207R00000X
MN104510207R00000X
KS0438272207RC0000X
390200000X
KS04-38272207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00773915OtherMEDICARE RAILROAD
KS201133590AMedicaid
MNENROLLEDMedicaid