Provider Demographics
NPI:1831187483
Name:HALABI, ALI S (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:S
Last Name:HALABI
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 41194
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44141-0194
Mailing Address - Country:US
Mailing Address - Phone:216-883-1234
Mailing Address - Fax:216-883-7706
Practice Address - Street 1:5316 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1507
Practice Address - Country:US
Practice Address - Phone:216-883-1234
Practice Address - Fax:216-883-7706
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045146N208600000X
OH35045146H208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448779Medicaid
OH0898141Medicare PIN
A80156Medicare UPIN