Provider Demographics
NPI:1205584687
Name:IBRAHIM, KADRA ELMI
Entity type:Individual
Prefix:
First Name:KADRA
Middle Name:ELMI
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 W HAPPFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7143
Mailing Address - Country:US
Mailing Address - Phone:874-873-2258
Mailing Address - Fax:
Practice Address - Street 1:995 W HAPPFIELD DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7143
Practice Address - Country:US
Practice Address - Phone:874-873-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based