Provider Demographics
NPI:1174519862
Name:IBRAHIM, KAMAL N (MD)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:N
Last Name:IBRAHIM
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 1:4300 COMMERCE CT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3698
Mailing Address - Country:US
Mailing Address - Phone:630-968-1881
Mailing Address - Fax:630-245-9098
Practice Address - Street 1:1S224 SUMMIT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3983
Practice Address - Country:US
Practice Address - Phone:630-620-4141
Practice Address - Fax:630-620-4174
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207X00000X, 207XP3100X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00242697OtherRAILROAD MEDICARE
ILP00242697OtherRAILROAD MEDICARE
ILC45286Medicare UPIN
IL0371240002Medicare NSC