MEDICARE: FADI A HABIB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	01084503A	IN
2	208800000X	Urology Physician	036085999	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	815500439	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013963164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FADI A HABIB MD

Provider Business Mailing Address
First Line	:	5600 W ADDISON ST
Second Line	:	SUITE 305
City	:	CHICAGO
State	:	IL
Zip	:	60634-4401
Country	:	US
Telephone Number	:	773-725-0760
Fax Number	:	773-725-3499

Provider Business Practice Location Address
First Line	:	5600 W ADDISON ST
Second Line	:	SUITE 305
City	:	CHICAGO
State	:	IL
Zip	:	60634-4401
Country	:	US
Telephone Number	:	773-725-0760
Fax Number	:	773-725-3499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/10/2024

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Directions to “ FADI A HABIB MD” Practice Location

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