Healthcare Provider Details

I. General information

NPI: 1760479018
Provider Name (Legal Business Name): NABIL A EBRAHEIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 CHERRY ST STE 10
TOLEDO OH
43608-2625
US

IV. Provider business mailing address

2409 CHERRY ST STE 10
TOLEDO OH
43608-2625
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-6784
  • Fax: 419-251-6787
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number35052443
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35052443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: