Provider Demographics
NPI:1588636435
Name:HABIB, ISAM HASAN (MD)
Entity Type:Individual
Prefix:
First Name:ISAM
Middle Name:HASAN
Last Name:HABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-346-7934
Mailing Address - Fax:317-346-2712
Practice Address - Street 1:1155 W JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131
Practice Address - Country:US
Practice Address - Phone:317-346-3883
Practice Address - Fax:317-346-3141
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33631207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200907990Medicaid
WI0534 20195Medicare ID - Type Unspecified
WI31945000Medicaid
WI002150269Medicare Oscar/Certification