Provider Demographics
NPI:1023092616
Name:JAWAD, IBRAHIM A (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:A
Last Name:JAWAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20671 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2757
Mailing Address - Country:US
Mailing Address - Phone:313-903-2100
Mailing Address - Fax:844-225-2914
Practice Address - Street 1:20671 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2757
Practice Address - Country:US
Practice Address - Phone:313-903-2100
Practice Address - Fax:844-225-2914
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044506207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F319250OtherBLUE SHIELD
MI1023092616Medicaid
MI110241691OtherRR MEDICARE
MIB47888Medicare UPIN
MI0N53930005Medicare PIN