Provider Demographics
NPI:1922617778
Name:SERENITY FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:SERENITY FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NOOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-380-3700
Mailing Address - Street 1:767 PARK AVE W STE 180
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2470
Mailing Address - Country:US
Mailing Address - Phone:847-380-3700
Mailing Address - Fax:
Practice Address - Street 1:767 PARK AVE W
Practice Address - Street 2:STE 180
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-380-3700
Practice Address - Fax:877-540-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty