Provider Demographics
NPI:1477862563
Name:IBRAHIM, AMER (MD)
Entity type:Individual
Prefix:DR
First Name:AMER
Middle Name:
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 1:522 42ND ST S
Mailing Address - Street 2:APT # 194
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1167
Mailing Address - Country:US
Mailing Address - Phone:701-388-3893
Mailing Address - Fax:
Practice Address - Street 1:1919 ELM ST N
Practice Address - Street 2:CLINICAL NEUROSCIENCES
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2416
Practice Address - Country:US
Practice Address - Phone:701-293-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDTRL 115552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry