Provider Demographics
NPI:1659336857
Name:HABIB, FAHIM A (MD)
Entity type:Individual
Prefix:
First Name:FAHIM
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 1:20333 N 19TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-9901
Mailing Address - Country:US
Mailing Address - Phone:480-707-9504
Mailing Address - Fax:602-581-7764
Practice Address - Street 1:20333 N 19TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-9901
Practice Address - Country:US
Practice Address - Phone:480-707-9504
Practice Address - Fax:602-581-7764
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455975208600000X, 2086S0102X
AZ586392086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0147768Medicaid
FL2716178-00Medicaid
FLI26149Medicare UPIN
PA462096PNLMedicare UPIN