Provider Demographics
NPI:1740820174
Name:HEMAADA, IBRAHIM SULAIMAN
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:SULAIMAN
Last Name:HEMAADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 W WINSLOW AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7705
Mailing Address - Country:US
Mailing Address - Phone:602-751-1699
Mailing Address - Fax:
Practice Address - Street 1:7600 MONTGOMERY BLVD NE APT 1065
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1523
Practice Address - Country:US
Practice Address - Phone:602-751-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD02184121172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver