Provider Demographics
NPI:1700872546
Name:SEWIELAM, AHMED IBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:IBRAHIM
Last Name:SEWIELAM
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 1:1628 CRABB RIVER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5890
Mailing Address - Country:US
Mailing Address - Phone:832-526-8917
Mailing Address - Fax:
Practice Address - Street 1:1628 CRABB RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5890
Practice Address - Country:US
Practice Address - Phone:832-526-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL59022081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165902103Medicaid
TX8B2307OtherBCBS
TX165902104Medicaid
TX400576YKTVMedicare PIN
TX165902104Medicaid
TX165902103Medicaid