MEDICARE: BILANE C IBRAHIM

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	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	UH278071	OH

General Provider Information

NPI Number	:	1457225104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILANE C IBRAHIM

Provider Business Mailing Address
First Line	:	535 OLENTANGY RESERVE PLACE
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035
Country	:	US
Telephone Number	:	740-602-4061
Fax Number	:

Provider Business Practice Location Address
First Line	:	572 S NELSON RD STE C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2577
Country	:	US
Telephone Number	:	614-379-1490
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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Directions to “ BILANE C IBRAHIM ” Practice Location

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