Provider Demographics
NPI:1851592570
Name:MIZYED, IBRAHEEM M (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHEEM
Middle Name:M
Last Name:MIZYED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1871 W ORANGE GROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1289
Mailing Address - Country:US
Mailing Address - Phone:520-219-8342
Mailing Address - Fax:520-219-7117
Practice Address - Street 1:1871 W ORANGE GROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1289
Practice Address - Country:US
Practice Address - Phone:520-219-8342
Practice Address - Fax:520-219-7717
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ40955207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ365127Medicaid
AZZ125020Medicare PIN