Healthcare Provider Details

I. General information

NPI: 1992436059
Provider Name (Legal Business Name): HUSAM A KATIB MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 COMMERCE WAY APT 3311
MIAMI LAKES FL
33016-1666
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 917-251-8750
  • Fax:
Mailing address:
  • Phone: 954-262-1425
  • Fax: 954-262-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number182344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: