Provider Demographics
NPI:1720433212
Name:IBRAHIM, NOOREEN (DPM)
Entity Type:Individual
Prefix:
First Name:NOOREEN
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 PARK AVE W STE 180
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2470
Mailing Address - Country:US
Mailing Address - Phone:847-380-3700
Mailing Address - Fax:815-526-3467
Practice Address - Street 1:767 PARK AVE W STE 180
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2470
Practice Address - Country:US
Practice Address - Phone:847-380-3700
Practice Address - Fax:877-540-0387
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005858213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery