Healthcare Provider Details

I. General information

NPI: 1184287161
Provider Name (Legal Business Name): MOHAMED ABDELHABIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E BROADWAY RD STE 107
MESA AZ
85206-1346
US

IV. Provider business mailing address

5151 E BROADWAY RD STE 107
MESA AZ
85206-1346
US

V. Phone/Fax

Practice location:
  • Phone: 480-290-7000
  • Fax: 480-325-3461
Mailing address:
  • Phone: 480-290-7000
  • Fax: 602-254-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65618
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number65618
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number65618
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: