Provider Demographics
NPI:1699979252
Name:GHULMIYYAH, LABIB MIKRAM (MD)
Entity type:Individual
Prefix:DR
First Name:LABIB
Middle Name:MIKRAM
Last Name:GHULMIYYAH
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 1:1608 SE 3RD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-958-9959
Mailing Address - Fax:855-855-2793
Practice Address - Street 1:1625 SE 3RD AVE STE 415-A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-958-9959
Practice Address - Fax:855-855-2793
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146339207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3708246618OtherMYUTMB 3708246618-COMMERCIAL NUMBER
FL107802100Medicaid