| Fadi Ibrahim, Md Pc | |
|
31313 Northwestern Hwy Ste 203 Farmington Hills MI 48334-2577 | |
| (248) 880-0123 | |
| Not Available |
| Full Name | Fadi Ibrahim, Md Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 31313 Northwestern Hwy Ste 203, Farmington Hills, Michigan |
| Authorized Official Name and Position | Fadi Ibrahim (PROVIDER) |
| Authorized Official Contact | 2488800123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fadi Ibrahim, Md Pc 31313 Northwestern Hwy Ste 203 Farmington Hills MI 48334-2577 Ph: (248) 880-0123 | Fadi Ibrahim, Md Pc 31313 Northwestern Hwy Ste 203 Farmington Hills MI 48334-2577 Ph: (248) 880-0123 |
| NPI Number | 1841769627 |
|---|---|
| Provider Enumeration Date | 11/21/2018 |
| Last Update Date | 06/24/2021 |
| Medicare PECOS PAC ID | 0244577286 |
|---|---|
| Medicare Enrollment ID | O20190129001054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841769627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Louise Osbourn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376597138 PECOS PAC ID: 4385601806 Enrollment ID: I20041216000522 |
| Provider Name | Fadi I Ibrahim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396997912 PECOS PAC ID: 4284812140 Enrollment ID: I20110623000178 |
| Provider Name | Caroline L Derrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295893055 PECOS PAC ID: 9638312283 Enrollment ID: I20130829000095 |
| Provider Name | Choolwe Virginia Mupunga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770942708 PECOS PAC ID: 4981997806 Enrollment ID: I20160728002609 |
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