MEDICARE: IBRAHIM KHURRAM NAWAZ 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	11023229A	IN

General Provider Information

NPI Number	:	1457036022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAHIM KHURRAM NAWAZ MD

Provider Business Mailing Address
First Line	:	2817 WESTBROOK DR APT 217
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-2025
Country	:	US
Telephone Number	:	260-298-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 WESTBROOK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-2063
Country	:	US
Telephone Number	:	260-698-5033
Fax Number	:

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

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	07/23/2023

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