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General NPI Number Information
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NPI Number | 1861566119
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Entity Type | Individual
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Provider Name | ISSAM AFIF HALABY M.D.,PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 436 NOKOMIS AVE S
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City | VENICE
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State | FL
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Zip | 34285-2617
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Country | US
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Telephone | 941-445-5054
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Fax | 941-303-6796
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Provider Business Mailing Address
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Address Line | 436 NOKOMIS AVE S
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City | VENICE
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State | FL
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Zip | 34285-2617
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Country | US
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Telephone | 941-445-5054
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Fax | 941-303-6796
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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 | ME83954
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License Number State | FL
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