1164728937 NPI number — RENEE TALAAT ISHAK LABIB RPT, CLT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164728937 NPI number — RENEE TALAAT ISHAK LABIB RPT, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABIB
Provider First Name:
RENEE
Provider Middle Name:
TALAAT ISHAK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUSSOF
Provider Other First Name:
ERINY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164728937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28051 DEQUINDRE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-584-4625
Provider Business Mailing Address Fax Number:
313-584-5676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5445 OAKMAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-584-4625
Provider Business Practice Location Address Fax Number:
313-584-5676
Provider Enumeration Date:
01/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  5501014337 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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