MEDICARE: IBRAHIM ENAB

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	225100000X	Physical Therapist	070006155	IL
2	225100000X	Physical Therapist	PT 12470	FL

General Provider Information

NPI Number	:	1932431558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAHIM ENAB

Provider Business Mailing Address
First Line	:	1943 W SUMMERDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1040
Country	:	US
Telephone Number	:	312-607-6296
Fax Number	:	773-293-0132

Provider Business Practice Location Address
First Line	:	1943 W SUMMERDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1040
Country	:	US
Telephone Number	:	312-607-6296
Fax Number	:	773-293-0132

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

Provider Enumeration Date	:	02/06/2010
Last Update Date	:	02/06/2010

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Directions to “ IBRAHIM ENAB ” Practice Location

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