Healthcare Provider Details

I. General information

NPI: 1023092616
Provider Name (Legal Business Name): IBRAHIM A JAWAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20671 WILLIAMSBURG RD
DEARBORN HEIGHTS MI
48127-2757
US

IV. Provider business mailing address

20671 WILLIAMSBURG RD
DEARBORN HEIGHTS MI
48127-2757
US

V. Phone/Fax

Practice location:
  • Phone: 313-903-2100
  • Fax: 844-225-2914
Mailing address:
  • Phone: 313-903-2100
  • Fax: 844-225-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301044506
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: