Healthcare Provider Details

I. General information

NPI: 1114412822
Provider Name (Legal Business Name): IBRAHIM EL HALABI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 WOODMERE BLVD
MONTGOMERY AL
36106-3065
US

IV. Provider business mailing address

47 NEW SCOTLAND AVENUE, DEPT. OF INTERNAL MEDICINE
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-0814
  • Fax: 334-288-3417
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number46381
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: