Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301044506 | MI |
NPI | 1023092616 |
---|---|
Provider Name | Dr. Ibrahim A Jawad |
First Address | Dearborn Heights, MI 48127-2757 |
Second Address | Dearborn Heights, MI 48127-2757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023092616 | (05) | MI |
110241691 | RR MEDICARE (01) | MI |
700F319250 | BLUE SHIELD (01) | MI |
B47888 | (02) | MI |