Provider Demographics
NPI:1447006739
Name:THAYYIL, HIBAA LUQMAN (DO MEDICAL STUDENT)
Entity type:Individual
Prefix:
First Name:HIBAA
Middle Name:LUQMAN
Last Name:THAYYIL
Suffix:
Gender:
Credentials:DO MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 BIRUNI ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2610
Mailing Address - Country:US
Mailing Address - Phone:214-789-3451
Mailing Address - Fax:
Practice Address - Street 1:4603 BIRUNI ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2610
Practice Address - Country:US
Practice Address - Phone:214-789-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2025-04-07
Deactivation Date:2025-03-26
Deactivation Code:
Reactivation Date:2025-04-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program