Healthcare Provider Details

I. General information

NPI: 1659336857
Provider Name (Legal Business Name): FAHIM A. HABIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 230
PHOENIX AZ
85027-9901
US

IV. Provider business mailing address

20333 N 19TH AVE STE 230
PHOENIX AZ
85027-9901
US

V. Phone/Fax

Practice location:
  • Phone: 480-707-9504
  • Fax: 602-581-7764
Mailing address:
  • Phone: 480-707-9504
  • Fax: 602-581-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD455975
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD455975
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number58639
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: