Fahim K Ibrahim M.D., P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

FI067033 Issued in MI

Legal business name

FAHIM K IBRAHIM M.D., P.C.

Practice address

4190 24TH Ave
Suite 204
Fort Gratiot, MI 48059-3882

Phone

(810) 989-7702

Fax

(810) 989-7703

NPI assigned

Apr 4, 2008

Organization subpart

No

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

Authorized official

Name

Hania Ibrahim

Title

Office Manager

Phone

(810) 989-7702

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fahim K Ibrahim, MD

  • Ophthalmology Physician
  • Fort Gratiot, MI
  • NPI 1376611251
  Medicare reassignment

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

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1225201767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "address_2": "SUITE 204",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7702",
            "fax_number": "810-989-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "address_2": "SUITE 204",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7702",
            "fax_number": "810-989-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAHIM K IBRAHIM M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-04",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "HANIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "810-989-7702"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "FI067033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1807400741",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3350540",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "180028723",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Endocrinology and Diabetes Center of Port Huron PLLC
• Emily Erdmann
• Christina Evanko, BCBA, LBA
• Sarah L Evans
• Amy Fabick, MSW
• Alicia M Farias
• Rubaiya Faruque
• Kennedy Felax
• Alexa S Fischer
• Samantha May Fitz

• Specialist in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.