Provider Demographics
NPI:1972174332
Name:IBRAHEM, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:IBRAHEM
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 1:5215 CENTRE AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:724-719-7136
Mailing Address - Fax:
Practice Address - Street 1:5230 CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-623-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2023-05-16
Deactivation Date:2023-04-06
Deactivation Code:
Reactivation Date:2023-05-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program