Individual
MIRIAM LELA IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1107 S TILLOTSON AVE, STE 1, MUNCIE, IN 47304-4517
(765) 213-3024
(765) 282-9303
Mailing address
PO BOX 1889, MUNCIE, IN 47308-1889
(765) 284-0493
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01047444A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20174740
—
IN
Enumeration date
06/14/2006
Last updated
12/11/2019
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