Provider Demographics
NPI:1063932002
Name:HABIBULLAH, AYAAZ A (MD)
Entity type:Individual
Prefix:
First Name:AYAAZ
Middle Name:A
Last Name:HABIBULLAH
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 1:900 W NIFONG BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4469
Mailing Address - Country:US
Mailing Address - Phone:573-499-9009
Mailing Address - Fax:
Practice Address - Street 1:1000 W NIFONG BLVD STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5615
Practice Address - Country:US
Practice Address - Phone:573-444-6331
Practice Address - Fax:855-576-4137
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125071326207Q00000X
MO2020019624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine