Provider Demographics
NPI:1720974819
Name:PEDIYAKKAL, HIBA FATHIMA (MD)
Entity type:Individual
Prefix:
First Name:HIBA
Middle Name:FATHIMA
Last Name:PEDIYAKKAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 E HOSPITAL DR FL 9
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-4000
Mailing Address - Country:US
Mailing Address - Phone:734-763-6295
Mailing Address - Fax:
Practice Address - Street 1:1540 E HOSPITAL DR FL 9
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-4000
Practice Address - Country:US
Practice Address - Phone:734-763-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351054615207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty