Provider Demographics
NPI:1326067455
Name:IBRAHIM, FIKRY F (MD)
Entity Type:Individual
Prefix:DR
First Name:FIKRY
Middle Name:F
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20825 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1485
Mailing Address - Country:US
Mailing Address - Phone:313-886-0006
Mailing Address - Fax:
Practice Address - Street 1:20825 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1485
Practice Address - Country:US
Practice Address - Phone:313-886-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI031520207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI06327OtherHAP
MI031520OtherMI MEDICAL LICENCE
MI08933N FS 2131520OtherCHAMPUS
MI1108260481OtherBCBSM
MI1375432Medicaid
MI38-219-6003OtherFED TAX ID
MI08933N FS 2131520OtherCHAMPUS
MIB44566Medicare UPIN