Elite Sports & Regenerative Medicine PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

ELITE SPORTS & REGENERATIVE MEDICINE PLLC

Practice address

1022 N Telegraph Rd Ste 2
Dearborn, MI 48128-1622

Phone

(313) 764-0088

Fax

(313) 254-3586

NPI assigned

Jun 13, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Mohammad Ibrahim, DONPI 1962024968

Title

Manager

Phone

(313) 764-0088

Specialties & licenses 1

Addresses

Other names 1

• Elite Sports & Regenerative Medicine Other name

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.

• Mohammad Ibrahim, DO

  • Sports Medicine (Family Medicine) Physician
  • Dearborn, MI
  • NPI 1962024968
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1749772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1619863933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 N TELEGRAPH RD STE 2",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481281622",
            "telephone_number": "313-764-0088",
            "fax_number": "313-254-3586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 N TELEGRAPH RD STE 2",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481281622",
            "telephone_number": "313-764-0088",
            "fax_number": "313-254-3586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SPORTS & REGENERATIVE MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-13",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "313-764-0088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Sports & Regenerative Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Sports Medicine (Family Medicine) Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Sports Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.