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General NPI Number Information
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NPI Number | 1689873010
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Entity Type | Individual
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Provider Name | OMAR HABIB MD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 22201 MOROSS RD SUITE 356
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City | DETROIT
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State | MI
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Zip | 48236-2169
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Country | US
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Telephone | 313-343-7444
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Fax | 313-343-7999
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Provider Business Mailing Address
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Address Line | 22201 MOROSS RD SUITE 356
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City | DETROIT
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State | MI
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Zip | 48236-2169
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Country | US
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Telephone | 313-343-7444
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Fax | 313-343-7999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301074889
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M7238
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD60030929
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 4301074889
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036.124511
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License Number State | IL
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