Provider Demographics
NPI:1598704280
Name:IBRAHIM, EMAD L (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:L
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EMAD
Other - Middle Name:L
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 46245
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0103
Mailing Address - Country:US
Mailing Address - Phone:813-363-7818
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:JAMES A. HALEY VA HOSPITAL
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080417207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5171Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FMH32284Medicare UPIN