MEDICARE: DR. MAJD 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	207RC0000X	Cardiovascular Disease Physician	25MA11729500	NJ
2	207RC0000X	Cardiovascular Disease Physician	10196385-1205	UT
3	207RC0000X	Cardiovascular Disease Physician	130389	MT

General Provider Information

NPI Number	:	1700199627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAJD IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	50 W BROADWAY STE 300
Second Line	:
City	:	SALT LAKE CTY
State	:	UT
Zip	:	84101-2044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 W BROADWAY STE 300
Second Line	:
City	:	SALT LAKE CTY
State	:	UT
Zip	:	84101-2044
Country	:	US
Telephone Number	:	801-738-8938
Fax Number	:

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	01/29/2026

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