Provider Demographics
NPI:1851307409
Name:HABIB, FAKHER (MD)
Entity Type:Individual
Prefix:DR
First Name:FAKHER
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 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2184
Mailing Address - Country:US
Mailing Address - Phone:708-799-1100
Mailing Address - Fax:708-799-8343
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:708-799-1100
Practice Address - Fax:708-799-8343
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF79216Medicare UPIN
IL343920Medicare ID - Type Unspecified