Provider Demographics
NPI:1821312380
Name:SHAWQI E HALABU M.D. PC
Entity Type:Organization
Organization Name:SHAWQI E HALABU M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWQI
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALABU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-615-2020
Mailing Address - Street 1:23133 ORCHARD LAKE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3279
Mailing Address - Country:US
Mailing Address - Phone:248-615-2020
Mailing Address - Fax:248-615-4055
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 204
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3279
Practice Address - Country:US
Practice Address - Phone:248-615-2020
Practice Address - Fax:248-615-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISHO42299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI60F390260OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0F39026OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIA74125Medicare UPIN