Provider Demographics
NPI:1801209630
Name:BELLO, HABEEB A (DO)
Entity Type:Individual
Prefix:DR
First Name:HABEEB
Middle Name:A
Last Name:BELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1651 KINGSWAY CT STE A
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1959
Mailing Address - Country:US
Mailing Address - Phone:734-671-2110
Mailing Address - Fax:734-671-5344
Practice Address - Street 1:1651 KINGSWAY CT STE A
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183
Practice Address - Country:US
Practice Address - Phone:734-671-2110
Practice Address - Fax:734-671-5344
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021132207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801209630Medicaid