MEDICARE: ALI S. HALABI, M.D., INC

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	261QP2300X	Primary Care Clinic/Center	35045146	OH

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	:	1447420948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI S. HALABI, M.D., INC

Provider Business Mailing Address
First Line	:	PO BOX 41194
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44141-0194
Country	:	US
Telephone Number	:	216-883-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	5316 BROADWAY AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1507
Country	:	US
Telephone Number	:	216-883-1234
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALI S HALABI
Credential	:	M.D.
Telephone Number	:	216-883-1234

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/11/2008

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