Provider Demographics
NPI:1043322126
Name:IBRAHIM, HICHAM MOHSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HICHAM
Middle Name:MOHSEN
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HICHAM
Other - Middle Name:MOHSEN
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4606 CEDAR SPRINGS RD
Mailing Address - Street 2:APT 1338
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1243
Mailing Address - Country:US
Mailing Address - Phone:214-857-0837
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057930A2084P0800X
TX470352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry