MEDICARE: DR. IBRAHIM M ALWAN DDS

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	122300000X	Dentist	600153615	WI
2	122300000X	Dentist	019035197	IL

General Provider Information

NPI Number	:	1316788805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBRAHIM M ALWAN DDS

Provider Business Mailing Address
First Line	:	650 WINTHROP AVE
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2975
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	W183N9609 APPLETON AVE
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-4501
Country	:	US
Telephone Number	:	262-677-3700
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	03/18/2025

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