Healthcare Provider Details

I. General information

NPI: 1013009265
Provider Name (Legal Business Name): IBRAHIM S. SADEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86TH MDG/SGHC UNIT 3215 RAMSTEIN AB
APO ARMED FORCES EUROPE
09094
DE

IV. Provider business mailing address

86TH MDG/SGHC UNIT 3215 RAMSTEIN AB
APO ARMED FORCES EUROPE
09094
DE

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036083248
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number036-083248
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036083248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: