Individual
IBRAHIM S ABU ROMEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 RONALD REAGAN PKWY, STE 171, AVON, IN 46123-6910
(317) 217-3000
(317) 273-5988
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01077129A
IN
207RC0000X
Cardiovascular Disease Physician
4301100113
MI
207RI0011X
Interventional Cardiology Physician
Primary
01077129A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001027334
ANTHEM PTAN
IN
01
—
000001027338
ANTHEM PTAN
IN
01
—
000001624244
ANTHEM PTAN
IN
01
—
11808031
CAQH
MI
01
—
1215129341
BCBS TYPE 1 (IND) NPI #
MI
05
—
1598968547
—
MI
05
—
201377520
—
IN
01
—
4301081138
MI LICENSE #
MI
01
—
5315053798
CDS #
MI
01
—
D0072852
STATE LICENSE #
MI
Enumeration date
08/13/2007
Last updated
05/05/2025
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