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NPI Code Detail

MEDICARE: JALAL IBRAHIM DO

MEDICARE:   JALAL  IBRAHIM  DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1497685648
Entity Type Code : Individual
Provider Name (Legal Business Name) : JALAL IBRAHIM DO
Provider Business Mailing Address
First Line : 1540 CROOKED STICK DR
Second Line :
City : VALRICO
State : FL
Zip : 33596-7815
Country : US
Telephone Number : 813-850-8488
Fax Number :
Provider Business Practice Location Address
First Line : 636 DEL PRADO BLVD S
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2668
Country : US
Telephone Number : 239-424-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/20/2026

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Directions to “ JALAL IBRAHIM DO” Practice Location

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