Active NPI
Amjad Ibrahim
- Psychiatric/Mental Health Nurse Practitioner
- Royal Oak, MI
National Provider Identifier
1487534889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 4704311666
- Practice address
- 220 S Main St
Royal Oak, MI 48067-2676 - Phone
- (248) 216-4704
- Fax
- (947) 245-4212
- NPI assigned
- Sep 5, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 4704311666 | MI | Primary |
Addresses
Primary practice location
220 S Main St
Royal Oak, MI 48067-2676
Mailing address
2969 Orchard PL
Orchard Lake, MI 48324-2362
Phone (248) 755-8585
Other practice location 1
1355 Bogue St
East Lansing, MI 48824-6207
Phone (800) 605-6424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1221 Bowers St
Unit 170
Birmingham, MI 48012-9996
500 W Jefferson St
Louisville, KY 40202-2881
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782950400000",
"number": "1487534889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2969 ORCHARD PL",
"city": "ORCHARD LAKE",
"state": "MI",
"postal_code": "483242362",
"telephone_number": "248-755-8585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 S MAIN ST",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480672676",
"telephone_number": "248-216-4704",
"fax_number": "947-245-4212"
}
],
"practiceLocations": [
{
"address_1": "1355 Bogue St",
"address_purpose": "LOCATION",
"city": "East Lansing",
"state": "MI",
"postal_code": "488246207",
"country_code": "US",
"telephone_number": "800-605-6424",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IBRAHIM",
"first_name": "AMJAD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-09-05",
"last_updated": "2026-07-02",
"certification_date": "2026-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MI",
"license": "4704311666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.