Rose M. Ibrahim M.D. PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

4301046478 Issued in MI

Legal business name

ROSE M. IBRAHIM M.D. PC

Practice address

13739 S Huron River Dr
Romulus, MI 48174-3628

Phone

(734) 941-0895

NPI assigned

Jul 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rose Ibrahim

Title

President

Phone

(734) 941-0895

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1093747818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1598 OLD CHATHAM DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483041040",
            "telephone_number": "734-941-0895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13739 S HURON RIVER DR",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481743628",
            "telephone_number": "734-941-0895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE M. IBRAHIM M.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-941-0895"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301046478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1592176",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Romulus, MI
• Providers in Romulus, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.