Provider Demographics
NPI:1982665154
Name:HABIB, SHAHID (MD)
Entity type:Individual
Prefix:
First Name:SHAHID
Middle Name:
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:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1124 COLUMBIA ST STE 600
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2046
Practice Address - Country:US
Practice Address - Phone:206-386-3660
Practice Address - Fax:206-386-3644
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43691207RG0100X, 207RI0008X
WI4641207RG0100X, 207RI0008X
NV14197207RG0100X
WAMD61516162207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100283913Medicaid
WA2281160Medicaid
WI100283913Medicaid