MEDICARE: DR. THERESE A IBRAHIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME94322	FL

General Provider Information

NPI Number	:	1063514172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESE A IBRAHIM MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 400
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2051
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 S NOVA RD STE 4&5
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-0410
Country	:	US
Telephone Number	:	386-615-8122
Fax Number	:	844-899-3686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	11/29/2021

Similar Medicare Providers

1821250721 — AARON J PORTER DO
Practice Location Address:

420 S NOVA RD STE 4&5
ORMOND BEACH, FL
32174-0410

Practice Phone: 386-615-8122
Practice Fax: 844-899-3686

1932174547 — MARIA GONTCHAROVA MD
Practice Location Address:

420 S NOVA RD STE 4&5
ORMOND BEACH, FL
32174-0410

Practice Phone: 386-615-8122
Practice Fax: 844-899-3686

1982666814 — MINA B ZAHEDI MD
Practice Location Address:

420 S NOVA RD STE 4&5
ORMOND BEACH, FL
32174-0410

Practice Phone: 386-615-8122
Practice Fax: 844-899-3686

1265816219 — METCARE OF ORMOND BEACH
Practice Location Address:

420 S NOVA RD , SUITE 4&5
ORMOND BEACH, FL
32174-0410

Practice Phone: 386-615-8122
Practice Fax: 386-615-8139

1528431558 — CENTERWELL PHARMACY, INC.
Practice Location Address:

420 S NOVA RD STE 4/5
ORMOND BEACH, FL
32174-0410

Practice Phone: 386-281-6633
Practice Fax:

1770094088 — MISS NHI MA DO PA-C
Practice Location Address:

420 S NOVA RD STE 4&5
ORMOND BEACH, FL
32174-0410

Practice Phone: 386-506-0111
Practice Fax:

Directions to “ DR. THERESE A IBRAHIM MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.