MEDICARE: IBRAHIM BOHSALI 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	207Y00000X	Otolaryngology Physician	ME0017794	FL
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	ME0017794	FL

General Provider Information

NPI Number	:	1548261472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAHIM BOHSALI MD

Provider Business Mailing Address
First Line	:	2215 NEBRASKA AVE
Second Line	:	STE 1-D
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4864
Country	:	US
Telephone Number	:	772-464-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 NEBRASKA AVE
Second Line	:	STE 1-D
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4864
Country	:	US
Telephone Number	:	772-464-8707
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/11/2025

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