Provider Demographics
NPI:1730171497
Name:RATHLE, HABIB (MD PEDIATRICS)
Entity type:Individual
Prefix:
First Name:HABIB
Middle Name:
Last Name:RATHLE
Suffix:
Gender:M
Credentials:MD PEDIATRICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W 24TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8366
Mailing Address - Country:US
Mailing Address - Phone:528-314-1100
Mailing Address - Fax:928-344-3565
Practice Address - Street 1:1025 W 24TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8366
Practice Address - Country:US
Practice Address - Phone:528-314-1100
Practice Address - Fax:928-344-3565
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ290718Medicaid
AZ290718Medicaid