Provider Demographics
NPI:1811003890
Name:UMAR, IBRAHIM SULEMAN (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:SULEMAN
Last Name:UMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:97 GREEN NUMBER 10 DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5093
Mailing Address - Country:US
Mailing Address - Phone:636-946-8152
Mailing Address - Fax:
Practice Address - Street 1:4200 N CLOVERLEAF DR
Practice Address - Street 2:SUITE N
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6436
Practice Address - Country:US
Practice Address - Phone:636-922-9182
Practice Address - Fax:636-922-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics