Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 36119 | TN |
Y | 207RP1001X | Pulmonary Disease | 36119 | TN |
N | 207RS0012X | Sleep Medicine | 36119 | TN |
NPI | 1043266752 |
---|---|
Provider Name | Ahmad Machhour Ibrahimbacha |
First Address | Cleveland, TN 37311-3883 |
Second Address | Cleveland, TN 37311-3883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 18/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3702756 | MEDICARE GROUP NUMBER (01) | TN |
3877399 | (05) | TN |
621482378 | BLUE RDG PUL MED TX ID (01) | TN |
F38338 | (02) | TN |