Provider Demographics
NPI:1730996182
Name:IBRAHIM, MOHAMMED NURUDEEN (PHD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:NURUDEEN
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 CAMPBELL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1650
Mailing Address - Country:US
Mailing Address - Phone:816-728-3157
Mailing Address - Fax:
Practice Address - Street 1:327 E 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6704
Practice Address - Country:US
Practice Address - Phone:816-728-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program