Provider Demographics
NPI:1558433201
Name:IBEWIRO, HELEN U (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:U
Last Name:IBEWIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:U
Other - Last Name:DIBIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5944 LAKE CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7671
Mailing Address - Country:US
Mailing Address - Phone:972-837-0009
Mailing Address - Fax:
Practice Address - Street 1:5944 LAKE CHAMPLAIN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-7671
Practice Address - Country:US
Practice Address - Phone:972-837-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91009208M00000X
FLME102353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A910090Medicaid
FLME102353OtherFLORIDA STATE MEDICAL LICENSE
00A910090Medicare ID - Type Unspecified
FLME102353OtherFLORIDA STATE MEDICAL LICENSE