MEDICARE: DR. AHMED IBRAHIM MD

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	207RC0000X	Cardiovascular Disease Physician	20592	WI
2	207R00000X	Internal Medicine Physician	35.098819	OH

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	:	1639481989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED IBRAHIM MD

Provider Business Mailing Address
First Line	:	10318 RESERVE DR APT 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3565
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 ALBERTA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2700
Country	:	US
Telephone Number	:	915-799-4341
Fax Number	:

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	04/19/2021

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Directions to “ DR. AHMED IBRAHIM MD” Practice Location

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