Provider Demographics
NPI:1194755157
Name:LABIB, ATEF S (MD)
Entity type:Individual
Prefix:
First Name:ATEF
Middle Name:S
Last Name:LABIB
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 1:4080 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9056
Mailing Address - Country:US
Mailing Address - Phone:330-507-2483
Mailing Address - Fax:
Practice Address - Street 1:4080 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9056
Practice Address - Country:US
Practice Address - Phone:330-507-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044422207RI0011X
OH35.044422207RC0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0530054Medicaid
OHH129961OtherMEDICARE PTAN
OHH129961OtherMEDICARE PTAN