Provider Demographics
NPI:1518353309
Name:IBRAHIM, JIMMY (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
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 1:1330 MERCY DR NW STE 418
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2625
Mailing Address - Country:US
Mailing Address - Phone:330-580-4706
Mailing Address - Fax:330-580-4707
Practice Address - Street 1:1330 MERCY DR NW STE 418
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2625
Practice Address - Country:US
Practice Address - Phone:330-580-4706
Practice Address - Fax:330-580-4707
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.139709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery