Provider Demographics
NPI:1174554687
Name:HABHAB, NIZAM ALI (DO)
Entity type:Individual
Prefix:
First Name:NIZAM
Middle Name:ALI
Last Name:HABHAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2822
Mailing Address - Country:US
Mailing Address - Phone:734-469-2887
Mailing Address - Fax:734-469-2890
Practice Address - Street 1:1244 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2822
Practice Address - Country:US
Practice Address - Phone:734-469-2887
Practice Address - Fax:734-469-2890
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINH012088207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4591477Medicaid
MIMI3805Medicare PIN
MIG94571Medicare UPIN