Healthcare Provider Details

I. General information

NPI: 1740662253
Provider Name (Legal Business Name): MICHEL IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9422 ARLINGTON EXPY
JACKSONVILLE FL
32225-8231
US

IV. Provider business mailing address

9422 ARLINGTON EXPY
JACKSONVILLE FL
32225-8231
US

V. Phone/Fax

Practice location:
  • Phone: 904-559-1844
  • Fax: 904-900-7707
Mailing address:
  • Phone: 904-559-1844
  • Fax: 904-900-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME159680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: