Individual
ABBAS M.B IBRAHIM SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12935 S GREGORY STREET, BLUE ISLAND, IL 60406
(708) 597-2000
Mailing address
10600 BROOKS LANE, CHICAGO RIDGE, IL 60415
(708) 717-3841
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
238.000314
IL
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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