=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447420948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALI S. HALABI, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2008
-----------------------------------------------------
Last Update Date | 03/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5316 BROADWAY AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44127-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-883-1234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 41194
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44141-0194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-883-1234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALI S HALABI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 216-883-1234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 35045146
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------