Provider Demographics
NPI:1013009265
Name:SADEK, IBRAHIM S (MD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:S
Last Name:SADEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86TH MDG/SGHC UNIT 3215
Mailing Address - Street 2:RAMSTEIN AB
Mailing Address - City:APO
Mailing Address - State:ARMED FORCES EUROPE
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86TH MDG/SGHC UNIT 3215
Practice Address - Street 2:RAMSTEIN AB
Practice Address - City:APO
Practice Address - State:ARMED FORCES EUROPE
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:314-479-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083248208D00000X, 2083X0100X
IL036-0832482083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2222741OtherBLUE CROSS BLUE SHIELD IL
IL542510Medicare ID - Type Unspecified
ILF22765Medicare UPIN