Individual
DR. MUHAMMED-RODWAN ALI HIBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12102 CORTEZ BLVD, BROOKSVILLE, FL 34613-5514
(352) 597-4000
(352) 597-0550
Mailing address
12102 CORTEZ BLVD STE 120, BROOKSVILLE, FL 34613-5514
(352) 597-4000
(352) 597-0550
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME 69833
FL
207RG0100X
Gastroenterology Physician
Primary
ME 69833
FL
207RI0008X
Hepatology Physician
ME 69833
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100016261
MEDICARE RAILROAD
—
01
—
1003105
HUMANA
—
01
—
21196012157-01
BEECH STREET
—
05
—
2579162-00
—
FL
01
—
2593473
GHI
—
01
—
29-87121
UNITED HEALTH CARE
—
01
—
49489
BLUE CROSS BLUE SHIELD
FL
01
—
7130082
AETNA
—
Enumeration date
08/28/2006
Last updated
03/30/2020
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