Provider Demographics
NPI:1477551455
Name:AMJAD, IBRAHIM H (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:H
Last Name:AMJAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 558568
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-8568
Mailing Address - Country:US
Mailing Address - Phone:305-267-8885
Mailing Address - Fax:305-265-0142
Practice Address - Street 1:1100 SW 57TH AVE
Practice Address - Street 2:PENTHOUSE #1
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5122
Practice Address - Country:US
Practice Address - Phone:305-267-8885
Practice Address - Fax:305-265-0142
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70663208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264381200Medicaid
FL264381200Medicaid
FLH69357Medicare UPIN
FL54168AMedicare PIN