Individual
DR. MIAN A. IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1214 COOLIDGE BLVD, LAFAYETTE, LA 70503-2621
(337) 261-7970
Mailing address
PO BOX 53127, LAFAYETTE, LA 70505-3127
(337) 261-7970
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24548
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486914
—
LA
Enumeration date
09/30/2005
Last updated
07/30/2008
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