Organization
ROSE M. IBRAHIM M.D. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE IBRAHIM (PRESIDENT)
(734) 941-0895
Entity
Organization
Contact information
Practice address
13739 S HURON RIVER DR, ROMULUS, MI 48174-3628
(734) 941-0895
Mailing address
1598 OLD CHATHAM DR, BLOOMFIELD HILLS, MI 48304-1040
(734) 941-0895
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301046478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1592176
—
MI
Enumeration date
07/06/2006
Last updated
01/11/2008
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