Provider Demographics
NPI:1346683505
Name:IBRAHIM, BASSEM BEBAWI (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:BEBAWI
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18550 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6751
Mailing Address - Country:US
Mailing Address - Phone:352-735-3755
Mailing Address - Fax:352-385-0033
Practice Address - Street 1:18550 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-735-3755
Practice Address - Fax:352-385-0033
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME126737207R00000X, 207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program