MEDICARE: KAMAL IBRAHIM PC

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	207R00000X	Internal Medicine Physician	4301073747	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1558372458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMAL IBRAHIM PC

Provider Business Mailing Address
First Line	:	PO BOX 871400
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-7300
Country	:	US
Telephone Number	:	313-397-1907
Fax Number	:	313-397-2125

Provider Business Practice Location Address
First Line	:	7612 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-2822
Country	:	US
Telephone Number	:	313-397-1907
Fax Number	:	313-397-2125

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAMAL MUSA IBRAHIM
Credential	:	MD
Telephone Number	:	313-397-1907

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/29/2015

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