MEDICARE: DR. FATIMA IBRAHIM M.D.

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	2084N0400X	Neurology Physician	M1780	TX
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	M1780	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00106W	OTHER	TX	MHS PHYS OF TX GRP PTAN - HARRIS COUNTY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	351187YNBT	OTHER	TX	MDCR PTAN MONTGOMERY CO.
4	351179YNBT	OTHER	TX	MDCR PTAN
5	0035TD	OTHER	TX	MHS PHYS OF TX BCBSTX GRP PROV REC #
6	00659N	OTHER	TX	MHS PHYS OF TX GRP PTAN - MONTGOMERY COUNTY
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487641718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FATIMA IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 132528
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-2528
Country	:	US
Telephone Number	:	713-876-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 S BAUER POINT CIR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-5326
Country	:	US
Telephone Number	:	281-586-8800
Fax Number	:	827-586-8822

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	11/03/2015

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