Organization
FAHIM K IBRAHIM M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANIA IBRAHIM (OFFICE MANAGER)
(810) 989-7702
Entity
Organization
Contact information
Practice address
4190 24TH AVE, SUITE 204, FORT GRATIOT, MI 48059-3882
(810) 989-7702
(810) 989-7703
Mailing address
4190 24TH AVE, SUITE 204, FORT GRATIOT, MI 48059-3882
(810) 989-7702
(810) 989-7703
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
FI067033
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180028723
PALMETTO GBA
MI
01
—
1807400741
BLUE CROSS
MI
05
—
3350540
—
MI
Enumeration date
04/04/2008
Last updated
10/19/2011
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