Individual
DENISE THERESA IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
133 E BRUSH HILL RD, ELMHURST, IL 60126-5659
(630) 501-0630
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-3698
(630) 469-2000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036105854
IL
207XP3100X
Pediatric Orthopaedic Surgery Physician
036105854
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105854
—
IL
01
—
P00610091
RAILROAD MEDICARE
IL
Enumeration date
09/27/2005
Last updated
10/07/2021
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