Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35087769 | OH |
Y | 208600000X | Surgeon | 35087769 | OH |
N | 2086S0120X | Pediatric Surgery | 35087769 | OH |
NPI | 1154379295 |
---|---|
Provider Name | Dr. Mohamed M Ibrahim |
First Address | Lockport, NY 14094-5226 |
Second Address | Lockport, NY 14094-5226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 10/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02836482 | (05) | NY |
H49190 | (02) |