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General NPI Number Information
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NPI Number | 1578374948
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Entity Type | Organization
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Legal Business Name | FATTY LIVER CLINIC PLLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 3238 E SPEEDWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85716-3934
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Country | US
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Telephone | 515-822-5585
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Fax | 520-445-7727
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Provider Business Mailing Address
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Address Line | 3232 E SPEEDWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85716-3934
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Country | US
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Telephone | 515-822-5585
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Fax | 520-445-7727
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Authorized Official
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Title or Position | OWNER
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Name | SHAHID HABIB
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Credential | MD
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Telephone | 515-822-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0100X
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Taxonomy Name | Gastroenterology Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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Taxonomy #4
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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