Provider Demographics
NPI:1689253460
Name:IBRAHIM, MINA RAFED
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:RAFED
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 BRANFORD DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1088
Mailing Address - Country:US
Mailing Address - Phone:248-513-0906
Mailing Address - Fax:
Practice Address - Street 1:11885 E 12 MILE RD STE 202A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3469
Practice Address - Country:US
Practice Address - Phone:248-865-4444
Practice Address - Fax:248-865-6161
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program