Healthcare Provider Details

I. General information

NPI: 1578741922
Provider Name (Legal Business Name): IBRAHIM MAKKI BINALSHEIKH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 9TH ST FL 4
SPRINGFIELD IL
62702-5310
US

IV. Provider business mailing address

1965 S FREMONT AVE STE 300
SPRINGFIELD MO
65804-2278
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 417-820-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number036.146944
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2016-01765
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2016-01765
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: