Healthcare Provider Details

I. General information

NPI: 1265426043
Provider Name (Legal Business Name): EMIL K IBRAHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARKVIEW DR APT 628
HALLANDALE BEACH FL
33009-2973
US

IV. Provider business mailing address

114 W 7TH ST STE 900
AUSTIN TX
78701-3013
US

V. Phone/Fax

Practice location:
  • Phone: 440-781-6940
  • Fax:
Mailing address:
  • Phone: 512-838-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35896-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-06-8896-1
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME106479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: