Basic Information
| Provider Information | |||||||||
| NPI: | 1447712799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABABIDI | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | LUTFI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 485 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473620485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655211516 | ||||||||
| FaxNumber: | 7655993131 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 WITTENBRAKER AVE | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473625000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655993100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2019 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 01088026A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.