Provider Demographics
NPI:1710089388
Name:IBRAHIM, ALI E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:E
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 JOE MANN BLVD STE P-6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8900
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:3085 HALLMARK CT STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6803
Practice Address - Country:US
Practice Address - Phone:989-996-0566
Practice Address - Fax:989-401-2876
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010831912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710089388Medicaid
MI700G360210OtherBCBSM
MI0999825OtherHEALTHPLUS
MIP00161003OtherRAILROAD MEDICARE
MI0731093OtherBCBSM
MI381870664OtherTAX ID
MIAI083191OtherLICENSE
MIP00161003OtherRAILROAD MEDICARE
MI0999825OtherHEALTHPLUS