Healthcare Provider Details

I. General information

NPI: 1861803595
Provider Name (Legal Business Name): RUKAYATU IBRAHIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W STATE ST
ROCKFORD IL
61102-2112
US

IV. Provider business mailing address

1200 W STATE ST
ROCKFORD IL
61102-2112
US

V. Phone/Fax

Practice location:
  • Phone: 815-490-1600
  • Fax: 815-490-1881
Mailing address:
  • Phone: 815-490-1600
  • Fax: 815-490-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036140870
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: