Provider Demographics
NPI:1275828212
Name:TUNA, IBRAHIM S (MD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:S
Last Name:TUNA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC RADIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-607-5280
Mailing Address - Fax:414-266-1525
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC RADIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-607-5280
Practice Address - Fax:414-266-1525
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2015-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI558742085P0229X
FLME1235982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014819100Medicaid
WI1275828212Medicaid
FLID633ZMedicare PIN