Healthcare Provider Details

I. General information

NPI: 1710548201
Provider Name (Legal Business Name): AHMED IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE B101
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

740 S LIMESTONE STE B101
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5661
  • Fax: 859-323-6411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number73389
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTP497
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberTP497
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: