MEDICARE: HOSSAM IBRAHIM M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME0058202	FL

General Provider Information

NPI Number	:	1639168990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOSSAM IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	6229 66TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5025
Country	:	US
Telephone Number	:	727-623-9913
Fax Number	:	727-803-6852

Provider Business Practice Location Address
First Line	:	6229 66TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5025
Country	:	US
Telephone Number	:	727-623-9913
Fax Number	:	727-803-6852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	12/29/2017

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