Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 5101023817 | MI |
Y | 208600000X | Surgeon | 5101023817 | MI |
NPI | 1013409291 |
---|---|
Provider Name | Peter Habib |
First Address | Farmington Hills, MI 48336-5919 |
Second Address | Farmington Hills, MI 48336-5919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 04/06/2018 |