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NPI Code Detail

MEDICARE: DR. LAMIS WAHID IBRAHIM M.D

MEDICARE: DR. LAMIS WAHID 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
1207RI0200XInfectious Disease Physician45997TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13714470OTHERTNGROUP MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780872358
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAMIS WAHID IBRAHIM M.D
Provider Business Mailing Address
First Line : PO BOX 699
Second Line :
City : MOUNTAIN HOME
State : TN
Zip : 37684-0699
Country : US
Telephone Number : 423-439-7280
Fax Number : 423-979-4134
Provider Business Practice Location Address
First Line : 615 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-8209
Country : US
Telephone Number : 423-930-8337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2007
Last Update Date : 01/18/2024

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