Individual
HAZEM TABBAA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1739
(833) 724-8326
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02005812A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034150
—
IN
Enumeration date
03/17/2014
Last updated
06/24/2020
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