Healthcare Provider Details

I. General information

NPI: 1598240210
Provider Name (Legal Business Name): IBRAHIM ALAMERI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

4746 MAIN ST
LISLE IL
60532-1724
US

V. Phone/Fax

Practice location:
  • Phone: 630-965-6793
  • Fax:
Mailing address:
  • Phone: 630-965-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number019.033413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: