# IBRAHIM MD SC

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

## Provider details

- **NPI number:** 1134119001
- **Authorized official:** HASSAN A IBRAHIM M.D. (PRESIDENT)
- **Authorized official phone:** (708) 342-1541

## Contact information

- **Practice address:** 6703 159TH ST, SUITE 105, TINLEY PARK, IL 60477-1781
- **Practice address phone:** (708) 342-1541
- **Practice address fax:** (708) 342-2673
- **Mailing address:** PO BOX 747, CHICAGO HEIGHTS, IL 60412-0747
- **Mailing address phone:** (708) 747-5850
- **Mailing address fax:** (708) 747-9991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/24/2005
- **Last updated:** 10/22/2007