Healthcare Provider Details

I. General information

NPI: 1558526285
Provider Name (Legal Business Name): AMMAR HABIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 W 74TH ST STE 350
MERRIAM KS
66204-2268
US

IV. Provider business mailing address

9119 W 74TH ST STE 350
MERRIAM KS
66204-2268
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9400
  • Fax: 913-632-9444
Mailing address:
  • Phone: 913-632-9400
  • Fax: 913-632-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52236
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number104510
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0438272
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number04-38272
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: