Provider Demographics
NPI:1710771191
Name:IBRAHIM, ABDELRAHMAN
Entity type:Individual
Prefix:
First Name:ABDELRAHMAN
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9TH STREET IBRAHIM SHERIF
Mailing Address - Street 2:803, KEROSIS BUILDING D
Mailing Address - City:ALEXANDRIA
Mailing Address - State:ALEXANDRIA
Mailing Address - Zip Code:21516
Mailing Address - Country:EG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-6369
Practice Address - Fax:612-904-4261
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program