Provider Demographics
NPI:1275730194
Name:JIBRINI, MHAMAD BADRADDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MHAMAD
Middle Name:BADRADDIN
Last Name:JIBRINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636267
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:859-838-1281
Mailing Address - Fax:859-838-1239
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:STE 200
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1396
Practice Address - Country:US
Practice Address - Phone:859-838-1281
Practice Address - Fax:859-838-1239
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40854207R00000X
OH35-092004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200926710Medicaid
OH2915000Medicaid
KY7100063060Medicaid
P00693655OtherRR MEDICARE
P00693655OtherRR MEDICARE
KY00805001Medicare PIN