Provider Demographics
NPI:1245780352
Name:DABKA, IBRAHIM ELHADI
Entity Type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:ELHADI
Last Name:DABKA
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 1:1150 SYRACUSE ST
Mailing Address - Street 2:#13-255
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3200
Mailing Address - Country:US
Mailing Address - Phone:720-217-1229
Mailing Address - Fax:
Practice Address - Street 1:1150 SYRACUSE ST APT 13-255
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3264
Practice Address - Country:US
Practice Address - Phone:720-217-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20151042317343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)