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1740256445

NPI Code Detail

MEDICARE: IBRAHIM BSHARA MD

MEDICARE: IBRAHIM BSHARA 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	207R00000X	Internal Medicine Physician	35063037B	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	3610861	OTHER		GROUP ASC MEDICARE
7	CA4511	OTHER		GROUP RR MEDICARE
8	CA4511	OTHER		RR MEDICARE GROUP
10	110099557	OTHER		RR MEDICARE INDIVIDUAL
11	9273172	OTHER		GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000031825	OTHER	OH	ANTHEM
2	10789186	OTHER		CAQH
3	1780634279	OTHER		GROUP NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	109285	OTHER		KAISER
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	D368301	OTHER		GROUP IND DIAGNOSTICS MED

General Provider Information

NPI Number	:	1740256445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAHIM BSHARA MD

Provider Business Mailing Address
First Line	:	20525 CENTER RIDGE RD
Second Line	:	SUITE 220
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116
Country	:	US
Telephone Number	:	440-895-5056
Fax Number	:	440-333-2935

Provider Business Practice Location Address
First Line	:	3665 W 117TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5215
Country	:	US
Telephone Number	:	216-351-0778
Fax Number	:	216-251-5963

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	09/29/2009

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Directions to “ IBRAHIM BSHARA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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