Provider Demographics
NPI:1508284126
Name:IBRAHIM, AHMED MOHAMED SAID (MD, PHD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:MOHAMED SAID
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5958
Mailing Address - Country:US
Mailing Address - Phone:321-727-3223
Mailing Address - Fax:
Practice Address - Street 1:707 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5958
Practice Address - Country:US
Practice Address - Phone:321-727-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138139208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2389955Medicaid