Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 017552 | NY |
Y | 225100000X | Physical Therapist | 070007653 | IL |
N | 2251N0400X | Physical Therapist - Neurology | 4951 | IL |
NPI | 1639155807 |
---|---|
Provider Name | Dr. Mohamed Attia Ibrahim |
First Address | Worth, IL 60482-0488 |
Second Address | Chicago, IL 60617-4710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 05/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1628667 | BCBS OF IL. PPO (01) | IL |
2498142 | UNITED HEALTH CARE (01) | |
731267 | OPTUM HEALTH (01) | IL |
7488668 | AETNA PPO (01) |