Provider Demographics
NPI:1992765317
Name:HABIB, FARIZ (MD)
Entity type:Individual
Prefix:
First Name:FARIZ
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 1:920 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048
Mailing Address - Country:US
Mailing Address - Phone:913-682-6200
Mailing Address - Fax:913-682-3244
Practice Address - Street 1:920 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-682-6200
Practice Address - Fax:913-682-3244
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04226432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
21285037OtherBLUE CROSS
045171OtherBLUE CROSS
KS100141800AMedicaid
KS100141800AMedicaid
045171OtherBLUE CROSS
0004106Medicare ID - Type Unspecified