Healthcare Provider Details

I. General information

NPI: 1528414653
Provider Name (Legal Business Name): ALI HABEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 76TH ST FL 2
PLEASANT PRAIRIE WI
53158-1984
US

IV. Provider business mailing address

9555 76TH ST
PLEASANT PRAIRIE WI
53158-1984
US

V. Phone/Fax

Practice location:
  • Phone: 262-577-8300
  • Fax: 262-577-8414
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number86662
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number70181
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number408864
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: