Provider Demographics
NPI:1013963164
Name:HABIB, FADI A (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:A
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 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-725-0760
Mailing Address - Fax:773-725-3499
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-725-0760
Practice Address - Fax:773-725-3499
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084503A208800000X
IL036085999208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN815500439OtherMEDICARE PTAN
IN300048939Medicaid