Individual
DR. MAZEN M IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9423 HIGHWAY 403, CHARLESTOWN, IN 47111-9664
(812) 256-6388
(812) 256-0475
Mailing address
9423 HIGHWAY 403, CHARLESTOWN, IN 47111-9664
(812) 256-6388
(812) 256-0475
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028371A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042374
ANTHEM
IN
05
—
100075220
—
IN
Enumeration date
03/15/2006
Last updated
01/20/2011
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