Healthcare Provider Details

I. General information

NPI: 1801688197
Provider Name (Legal Business Name): ABBAS HABIBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

IV. Provider business mailing address

200 RIVERFRONT DR APT 9F
DETROIT MI
48226-4598
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3937
  • Fax:
Mailing address:
  • Phone: 408-640-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number4352001183
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: