MEDICARE: IBRAHIM H. AMJAD, MD, PA

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	208200000X	Plastic Surgery Physician	ME 70663	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821271982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBRAHIM H. AMJAD, MD, PA

Provider Business Mailing Address
First Line	:	PO BOX 558568
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33255-8568
Country	:	US
Telephone Number	:	305-267-8885
Fax Number	:	305-265-0142

Provider Business Practice Location Address
First Line	:	1100 SW 57TH AVE
Second Line	:	PENTHOUSE #1
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5122
Country	:	US
Telephone Number	:	305-267-8885
Fax Number	:	305-265-0142

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IBRAHIM HOSAIN AMJAD
Credential	:	M.D.
Telephone Number	:	305-267-8885

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	10/14/2008

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