Provider Demographics
NPI:1801081948
Name:ABDULRAHMAN, IBRAHIM A (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:A
Last Name:ABDULRAHMAN
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 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:3900 S ZINTEL WAY
Practice Address - Street 2:KADLEC CLINIC - KENNEWICK PRIMARY CARE
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:509-783-2167
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60105626208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0306281OtherL&I NUMBER WA STATE
WA1801081948Medicaid
OR500625216OtherOREGON MEDICAID
WA1801081948Medicaid