Provider Demographics
NPI:1295726453
Name:IBRAHIM, BADRELDIN A (MD)
Entity type:Individual
Prefix:DR
First Name:BADRELDIN
Middle Name:A
Last Name:IBRAHIM
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 1:410 RUIDOSA DOWNS
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4608
Mailing Address - Country:US
Mailing Address - Phone:210-372-0450
Mailing Address - Fax:
Practice Address - Street 1:410 RUIDOSA DOWNS
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4608
Practice Address - Country:US
Practice Address - Phone:210-372-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM04382084N0400X, 2084N0600X
CODR.00548292084N0400X
CODR 0054829246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308865YN9DOtherADDITIONAL MEDICARE PIN
TX172522801Medicaid
TX172522801Medicaid
G93693Medicare UPIN