MEDICARE: ZAKI G 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	40758	CO
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	0441788	KS

General Provider Information

NPI Number	:	1689612889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAKI G IBRAHIM MD

Provider Business Mailing Address
First Line	:	305 W 15TH ST STE 101
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2455
Country	:	US
Telephone Number	:	620-624-0732
Fax Number	:	620-624-2513

Provider Business Practice Location Address
First Line	:	305 W 15TH ST STE 101
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2455
Country	:	US
Telephone Number	:	620-624-0732
Fax Number	:	620-624-2513

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/06/2026

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