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NPI Code Detail

MEDICARE: AHMED IBRAHIM MD

MEDICARE: 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
1207Y00000XOtolaryngology Physician01095370AIN
2390200000XStudent in an Organized Health Care Education/Training Program94-09146KS

General Provider Information

NPI Number : 1720515463
Entity Type Code : Individual
Provider Name (Legal Business Name) : AHMED IBRAHIM MD
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2920 S MCINTIRE DR STE 350
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-4215
Country : US
Telephone Number : 812-353-3277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2017
Last Update Date : 02/06/2026

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