Provider Demographics
NPI:1174784433
Name:HABIB, JOSEPH HASAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HASAN
Last Name:HABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-320-3380
Mailing Address - Fax:954-320-3371
Practice Address - Street 1:1601 S ANDREWS AVE FL 3
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2509
Practice Address - Country:US
Practice Address - Phone:954-320-3380
Practice Address - Fax:954-320-3371
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1142992086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14ML9OtherBCBS
GA003128529AMedicaid
FL006746300Medicaid
GA003128529AMedicaid