MEDICARE: STEVE IBRAHIM DO PLLC

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	314000000X	Skilled Nursing Facility	4396	AZ

General Provider Information

NPI Number	:	1063658334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE IBRAHIM DO PLLC

Provider Business Mailing Address
First Line	:	20118 N 67TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-4621
Country	:	US
Telephone Number	:	602-361-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	4065 E BELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2208
Country	:	US
Telephone Number	:	602-867-0212
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVE IBRAHIM I
Credential	:	D.O.
Telephone Number	:	602-361-3593

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2008

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