Provider Demographics
NPI:1043266752
Name:IBRAHIMBACHA, AHMAD MACHHOUR (M,D)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:MACHHOUR
Last Name:IBRAHIMBACHA
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DUNHILL PL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3883
Mailing Address - Country:US
Mailing Address - Phone:423-476-2212
Mailing Address - Fax:423-476-7022
Practice Address - Street 1:110 DUNHILL PL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3883
Practice Address - Country:US
Practice Address - Phone:423-476-2212
Practice Address - Fax:423-476-7022
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36119207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3877399Medicaid
TN621482378OtherBLUE RDG PUL MED TX ID
TN3702756OtherMEDICARE GROUP NUMBER
TN3702756OtherMEDICARE GROUP NUMBER
TN3877391Medicare ID - Type Unspecified