MEDICARE: JIMMY 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	208600000X	Surgery Physician	35.139709	OH

General Provider Information

NPI Number	:	1518353309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	1330 MERCY DR NW STE 418
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2625
Country	:	US
Telephone Number	:	330-580-4706
Fax Number	:	330-580-4707

Provider Business Practice Location Address
First Line	:	1330 MERCY DR NW STE 418
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2625
Country	:	US
Telephone Number	:	330-580-4706
Fax Number	:	330-580-4707

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

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	06/30/2022

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