Individual
SHARIQ M IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8317 CALUMET AVE, MUNSTER, IN 46321-1737
(219) 513-2333
(219) 513-2333
Mailing address
8317 CALUMET AVE, MUNSTER, IN 46321-1737
(219) 513-2333
(219) 513-2333
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01062605A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
01062605A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
01062605A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000494372
ANTHEM BCBS
IN
01
—
000000573813
ANTHEM BC/BS OF INDIANA
IN
05
—
200859300
—
IN
01
—
7163911
AETNA
IN
Enumeration date
09/15/2006
Last updated
04/30/2014
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