Healthcare Provider Details

I. General information

NPI: 1174569859
Provider Name (Legal Business Name): IBRAHIM ROBERT HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW POB III, SUITE 200A
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

PO BOX 830605
BIRMINGHAM AL
35283-0605
US

V. Phone/Fax

Practice location:
  • Phone: 205-786-2776
  • Fax: 205-786-6227
Mailing address:
  • Phone: 205-786-2776
  • Fax: 205-786-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number00027426
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number27426
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: