Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | IL | |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | IL | |
N | 207XS0117X | Orthopaedic Spine Surgeon | IL |
NPI | 1174519862 |
---|---|
Provider Name | Kamal N. Ibrahim |
First Address | Lisle, IL 60532-3698 |
Second Address | Oakbrook Terrace, IL 60181-3983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45286 | (02) | IL |
P00242697 | RAILROAD MEDICARE (01) | IL |