Individual
DR. FIKRY F IBRAHIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20825 MACK AVE, GROSSE POINTE WOODS, MI 48236-1485
(313) 886-0006
Mailing address
20825 MACK AVE, GROSSE POINTE WOODS, MI 48236-1485
(313) 886-0006
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
031520
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031520
MI MEDICAL LICENCE
MI
01
—
06327
HAP
MI
01
—
08933N FS 2131520
CHAMPUS
MI
01
—
1108260481
BCBSM
MI
05
—
1375432
—
MI
01
—
38-219-6003
FED TAX ID
MI
Enumeration date
07/19/2006
Last updated
03/29/2026
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