Healthcare Provider Details

I. General information

NPI: 1235527169
Provider Name (Legal Business Name): KAMEL IBRAHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

IV. Provider business mailing address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

V. Phone/Fax

Practice location:
  • Phone: 727-219-1833
  • Fax:
Mailing address:
  • Phone: 727-219-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME135642
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME135642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: