Provider Demographics
NPI:1538132881
Name:MIKHAIL, IMAN IBRAHIM (MD)
Entity Type:Individual
Prefix:MR
First Name:IMAN
Middle Name:IBRAHIM
Last Name:MIKHAIL
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 1:502 EUCLID AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-470-2300
Mailing Address - Fax:619-479-1580
Practice Address - Street 1:502 EUCLID AVE
Practice Address - Street 2:STE 205
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-470-2300
Practice Address - Fax:619-479-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA502880207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502880Medicaid
CAA50288AMedicare ID - Type Unspecified
F31933Medicare UPIN