Healthcare Provider Details

I. General information

NPI: 1760799050
Provider Name (Legal Business Name): JOHN NABIL BIBAWY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JFK DR STE 311
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

180 JFK DR STE 311
ATLANTIS FL
33462-6641
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0353
  • Fax: 561-357-0869
Mailing address:
  • Phone: 615-434-0353
  • Fax: 561-357-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME116693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: