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NPI Code Detail

MEDICARE: ISRAH IBRAHIM

MEDICARE: ISRAH 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538981188
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISRAH IBRAHIM
Provider Business Mailing Address
First Line : 244 E 90TH DR
Second Line :
City : MERRILLVILLE
State : IN
Zip : 46410-8102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3128 S WELLS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 716-436-8387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2024
Last Update Date : 10/25/2024

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Directions to “ ISRAH IBRAHIM ” Practice Location

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