Provider Demographics
NPI:1649267840
Name:SALIBI, HABBOUBA
Entity type:Individual
Prefix:MS
First Name:HABBOUBA
Middle Name:
Last Name:SALIBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-878-4202
Mailing Address - Fax:314-878-5812
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 260
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-878-4202
Practice Address - Fax:314-878-5812
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34303207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204891105Medicaid
MO204891105Medicaid
MOMA4459001Medicare PIN
000003950Medicare ID - Type Unspecified