Individual
JILL IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
40905
CO
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
DR.0040905
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50154575
—
CO
Enumeration date
10/25/2006
Last updated
12/04/2018
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