MEDICARE: MAHMOUD IBRAHIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1255296844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHMOUD IBRAHIM

Provider Business Mailing Address
First Line	:	7539 HARTWELL ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1572
Country	:	US
Telephone Number	:	313-675-6257
Fax Number	:

Provider Business Practice Location Address
First Line	:	7539 HARTWELL ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1572
Country	:	US
Telephone Number	:	313-675-6257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ MAHMOUD IBRAHIM ” Practice Location

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