Individual
AMR IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
IL
225100000X
Physical Therapist
Primary
070-008721
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634214
BCBS OF IL GROUP #
IL
Enumeration date
08/18/2006
Last updated
12/18/2019
Update your record
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