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Individual

DR. JOHN FIKRY MITYAS IBRAHIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
11S513 RACHAEL CT, WILLOWBROOK, IL 60527-6899
(331) 214-1843
Mailing address
11S513 RACHAEL CT, WILLOWBROOK, IL 60527-6899
(331) 214-1843

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036147616
IL
207R00000X
Internal Medicine Physician
125069705
IL
208M00000X
Hospitalist Physician
Primary
01084871A
IN
208M00000X
Hospitalist Physician
036147616
IL
208M00000X
Hospitalist Physician
1018-320
WI
208M00000X
Hospitalist Physician
ME151077
FL

Other

Enumeration date
08/29/2016
Last updated
11/06/2023
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