Provider Demographics
NPI:1578374948
Name:FATTY LIVER CLINIC PLLC
Entity type:Organization
Organization Name:FATTY LIVER CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-822-5585
Mailing Address - Street 1:3232 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3934
Mailing Address - Country:US
Mailing Address - Phone:515-822-5585
Mailing Address - Fax:520-445-7727
Practice Address - Street 1:3238 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3934
Practice Address - Country:US
Practice Address - Phone:515-822-5585
Practice Address - Fax:520-445-7727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVER INSTITUTE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy