# ROSE M. IBRAHIM M.D. PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093747818
- **Authorized official:** ROSE IBRAHIM (PRESIDENT)
- **Authorized official phone:** (734) 941-0895

## Contact information

- **Practice address:** 13739 S HURON RIVER DR, ROMULUS, MI 48174-3628
- **Practice address phone:** (734) 941-0895
- **Mailing address:** 1598 OLD CHATHAM DR, BLOOMFIELD HILLS, MI 48304-1040
- **Mailing address phone:** (734) 941-0895

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301046478 | MI | Yes |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 01/11/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1592176 | — | MI |