Provider Demographics
NPI:1871796979
Name:IBRAHIM, NOORI MIKHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:NOORI
Middle Name:MIKHAEL
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2971 MANGROVE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-4408
Mailing Address - Country:US
Mailing Address - Phone:586-323-2442
Mailing Address - Fax:
Practice Address - Street 1:6700 LYNCH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-4119
Practice Address - Country:US
Practice Address - Phone:313-252-2614
Practice Address - Fax:313-252-2898
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010746932083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine