Provider Demographics
NPI:1104863364
Name:IBRAHIM, BASSEL B (MD)
Entity Type:Individual
Prefix:
First Name:BASSEL
Middle Name:B
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-985-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:603 N FLAMINGO RD STE 255
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1013
Practice Address - Country:US
Practice Address - Phone:954-265-7900
Practice Address - Fax:954-981-1129
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME51232207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056347100Medicaid
E88781Medicare UPIN
12410WMedicare PIN