Organization
IBRAHIM MD SC
Active
Organization
IBRAHIM MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASSAN A IBRAHIM M.D. (PRESIDENT)
(708) 342-1541
Entity
Organization
Contact information
Practice address
6703 159TH ST, SUITE 105, TINLEY PARK, IL 60477-1781
(708) 342-1541
(708) 342-2673
Mailing address
PO BOX 747, CHICAGO HEIGHTS, IL 60412-0747
(708) 747-5850
(708) 747-9991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00021623342
BCBSIL GROUP NUMBER
—
Enumeration date
10/24/2005
Last updated
10/22/2007
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