Provider Demographics
NPI:1578556213
Name:EBRAHIM, SHEHAB AZMY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEHAB
Middle Name:AZMY
Last Name:EBRAHIM
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 1:2701 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6029
Mailing Address - Country:US
Mailing Address - Phone:504-455-0500
Mailing Address - Fax:504-455-3730
Practice Address - Street 1:2701 N CAUSEWAY BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6029
Practice Address - Country:US
Practice Address - Phone:504-455-0500
Practice Address - Fax:504-455-3730
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13621R207W00000X
LAMD13621R207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1424099Medicaid
I07247Medicare UPIN
LAP00333840Medicare PIN
LA1424099Medicaid
LAP00333840Medicare PIN
LA1424099Medicaid