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NPI Code Detail

MEDICARE: MONSURU IBRAHEEM MD INC A PROFESSIONAL CORPORATION

MEDICARE: MONSURU IBRAHEEM MD INC A PROFESSIONAL CORPORATION
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
1207R00000XInternal Medicine Physician11842NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427275874
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONSURU IBRAHEEM MD INC A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 98607
Second Line : DEPT 2022
City : LAS VEGAS
State : NV
Zip : 89193-8607
Country : US
Telephone Number : 646-209-6746
Fax Number :
Provider Business Practice Location Address
First Line : 1050 W GALLERIA DR
Second Line :
City : HENDERSON
State : NV
Zip : 89011-4800
Country : US
Telephone Number : 702-963-7000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MONSURU IBRAHEEM
Credential : M.D.
Telephone Number : 646-209-6746
Provider Enumeration Date : 04/19/2007
Last Update Date : 08/21/2019

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