Provider Demographics
NPI:1063404531
Name:HABIB-KHAZEN, FADIA K (MD)
Entity type:Individual
Prefix:
First Name:FADIA
Middle Name:K
Last Name:HABIB-KHAZEN
Suffix:
Gender:F
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:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-1934
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:4901 N 44TH ST STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2782
Practice Address - Country:US
Practice Address - Phone:602-954-0405
Practice Address - Fax:602-954-0485
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22782207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007204Medicaid
E83102Medicare UPIN
WDBGB01Medicare ID - Type Unspecified