Individual provider · Type 1 NPI
Abbas M.b Ibrahim Sr.
Surgical Physician Assistant · Blue Island, IL
NPI number
1396017984
Active
Practice location
12935 S Gregory Street
Blue Island, IL 60406
Mailing address
10600 Brooks Lane
Chicago Ridge, IL 60415
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgical Physician Assistant Primary | 363AS0400X | 238.000314 (IL) |
Surgical Physician Assistant: Definition to come...
About NPI 1396017984
Abbas M.b Ibrahim Sr.'s National Provider Identifier is 1396017984, issued on Jan 30, 2012. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Blue Island, IL. The record was last updated on Jan 30, 2012.