Healthcare Provider Details

I. General information

NPI: 1831418151
Provider Name (Legal Business Name): ROHAN ASHOK HABBU MS, MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 DEWBERRY PL NE APT 16
GRAND RAPIDS MI
49505-6918
US

IV. Provider business mailing address

1422 DEWBERRY PL NE APT 16
GRAND RAPIDS MI
49505-6918
US

V. Phone/Fax

Practice location:
  • Phone: 616-717-3860
  • Fax:
Mailing address:
  • Phone: 616-717-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2002031777
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: