Provider Demographics
NPI:1033744768
Name:OUMAR, IBRAHIM ACHEKH
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:ACHEKH
Last Name:OUMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOWE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7077
Mailing Address - Country:US
Mailing Address - Phone:207-577-4017
Mailing Address - Fax:
Practice Address - Street 1:48 HOWE ST APT 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7077
Practice Address - Country:US
Practice Address - Phone:207-577-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care