Individual
HISHAM IZZADIN IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1210 E PLANT ST STE 120, WINTER GARDEN, FL 34787-2995
(407) 297-8408
(407) 297-8408
Mailing address
3333 E CAMELBACK RD, STE 180, PHOENIX, AZ 85018-2396
(602) 759-6883
(602) 224-3315
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
17166
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619918760
—
NV
01
—
ME114722
LICENSE
FL
Enumeration date
06/09/2006
Last updated
03/25/2020
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