Marina Ibrahim, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

4351053668 Issued in MI

Practice address

1313 Stone St
Port Huron, MI 48060-3520

Phone

(810) 985-2620

Fax

(810) 962-8290

NPI assigned

Jun 19, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Water OB & GYN PC

  • Obstetrics & Gynecology Physician
  • Port Huron, MI
  • NPI 1508954603
  NPD
• McLaren Port Huron

  • Family Medicine Physician
  • Port Huron, MI
  • NPI 1619355930
  NPD (past)

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1497599161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 STONE ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603520",
            "telephone_number": "810-985-2620",
            "fax_number": "810-962-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 STONE ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603520",
            "telephone_number": "810-985-2620",
            "fax_number": "810-962-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MARINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351053668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wasif M Hussain, M.D.
• Britnie Anne Husson
• Debora Lynne Hutchins, LLPC
• Kyu Hwang, M.D.
• Rebecca Hycki, LMSW
• Michael Raymond Imbleau, CRNA
• Dawn Marie Iminski, LLMSW
• Impact
• Impact Services
• Incorporation to Maximize Personal Achievement With Community Training

• Student in an Organized Health Care Education/Training Program in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Student in an Organized Health Care Education/Training Program in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.