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NPI Code Detail

MEDICARE: ABDALLA KHALIL IBRAHIM MD, PHD

MEDICARE: ABDALLA KHALIL IBRAHIM MD, PHD
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
12085R0001XRadiation Oncology Physician4351056304MI

General Provider Information

NPI Number : 1417884610
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDALLA KHALIL IBRAHIM MD, PHD
Provider Business Mailing Address
First Line : 3601 W 13 MILE RD
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-6712
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 W 13 MILE RD
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-6712
Country : US
Telephone Number : 248-551-7032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/09/2026

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