Individual
ELMOATAZ IBRAHIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15945 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1147
(586) 263-0610
(586) 263-0834
Mailing address
43781 STONEY LN, STERLING HEIGHTS, MI 48313-2259
(586) 263-0610
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301094678
MI
2084N0400X
Neurology Physician
Primary
4301094678
MI
282NC0060X
Critical Access Hospital
—
—
390200000X
Student in an Organized Health Care Education/Training Program
57-014393
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-4754278
E.I. NEUROLOGY ASSOCIATES PLLC
MI
Enumeration date
09/12/2008
Last updated
11/23/2020
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