Provider Demographics
NPI:1740662253
Name:IBRAHIM, MICHEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9422 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8231
Mailing Address - Country:US
Mailing Address - Phone:904-559-1844
Mailing Address - Fax:904-900-7707
Practice Address - Street 1:9422 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8231
Practice Address - Country:US
Practice Address - Phone:904-559-1844
Practice Address - Fax:904-900-7707
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME159680207RC0000X
MA276030390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease