Provider Demographics
NPI:1639155807
Name:IBRAHIM, MOHAMED ATTIA (PT, DSC, MS, NCS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ATTIA
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:PT, DSC, MS, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-0488
Mailing Address - Country:US
Mailing Address - Phone:708-945-7171
Mailing Address - Fax:708-919-1535
Practice Address - Street 1:1925 E 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4710
Practice Address - Country:US
Practice Address - Phone:312-929-2950
Practice Address - Fax:312-224-4777
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017552225100000X
IL49512251N0400X
IL070007653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL731267OtherOPTUM HEALTH
7488668OtherAETNA PPO
IL1628667OtherBCBS OF IL. PPO
2498142OtherUNITED HEALTH CARE
201707145OtherHORIZON
201707145OtherGALAXY HEALTH NETWORK
IL1628667OtherBCBS OF IL. PPO
IL731267OtherOPTUM HEALTH
7488668OtherAETNA PPO
201707145OtherHORIZON