Healthcare Provider Details

I. General information

NPI: 1578885315
Provider Name (Legal Business Name): SAAD M. IBRAHIM M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 W JEFFERSON BLVD
FORT WAYNE IN
46804-4140
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-1568
  • Fax: 260-432-4969
Mailing address:
  • Phone: 614-293-8315
  • Fax: 614-293-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01077855A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01077855A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: