Provider Demographics
NPI:1861566119
Name:HALABY, ISSAM AFIF (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:ISSAM
Middle Name:AFIF
Last Name:HALABY
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 NOKOMIS AVE S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2617
Mailing Address - Country:US
Mailing Address - Phone:941-445-5054
Mailing Address - Fax:941-303-6796
Practice Address - Street 1:436 NOKOMIS AVE S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2617
Practice Address - Country:US
Practice Address - Phone:941-445-5054
Practice Address - Fax:941-303-6796
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83954208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12604OtherUNIVERSAL HEALTH CARE
FL2419854OtherCIGNA
FL08597OtherBCBS
FL303424OtherUNITED HEALTH CARE MPIN
FL59-1362995OtherGROUP TAX ID #
FL00778OtherBLUE CROSS BLUE SHIELD GROUP
FLP00303804OtherRAILROAD MEDICARE
FL59-1362995OtherGROUP TAX ID #
FLH57365Medicare UPIN
FL08597YMedicare ID - Type Unspecified