Healthcare Provider Details

I. General information

NPI: 1063932002
Provider Name (Legal Business Name): AYAAZ A HABIBULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W NIFONG BLVD STE 120
COLUMBIA MO
65203-5615
US

IV. Provider business mailing address

900 W NIFONG BLVD STE 101
COLUMBIA MO
65203-4469
US

V. Phone/Fax

Practice location:
  • Phone: 573-444-6331
  • Fax: 855-576-4137
Mailing address:
  • Phone: 573-499-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036154125
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125071326
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020019624
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: