Provider Demographics
NPI:1790862803
Name:SHALABY, IBRAHIM F (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:F
Last Name:SHALABY
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 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:1702 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-6204
Practice Address - Country:US
Practice Address - Phone:865-980-5370
Practice Address - Fax:865-980-5352
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38204011Medicaid
TN4152234OtherBCBST
TNG65602Medicare UPIN
TN38204011Medicaid
TNP00453247Medicare PIN