Provider Demographics
NPI:1629511035
Name:IBRAHIM HEART CLINIC PLLC
Entity type:Organization
Organization Name:IBRAHIM HEART CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORHAF
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-707-6817
Mailing Address - Street 1:5150 BELFORT RD BLDG 400
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6026
Mailing Address - Country:US
Mailing Address - Phone:904-580-4730
Mailing Address - Fax:904-580-4740
Practice Address - Street 1:5150 BELFORT RD BLDG 400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6026
Practice Address - Country:US
Practice Address - Phone:904-580-4730
Practice Address - Fax:904-580-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty