MEDICARE: DR. HAMIDULLAH HABIB FALA 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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	43045	AZ
2	207R00000X	Internal Medicine Physician	43045	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1124284625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMIDULLAH HABIB FALA MD

Provider Business Mailing Address
First Line	:	14749 W MOUNTAIN VIEW BLVD STE 138
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2704
Country	:	US
Telephone Number	:	623-738-0440
Fax Number	:	480-374-8051

Provider Business Practice Location Address
First Line	:	14749 W MOUNTAIN VIEW BLVD STE 138
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2704
Country	:	US
Telephone Number	:	623-738-0440
Fax Number	:	480-374-8051

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

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	05/08/2023

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