ABBAS M.B IBRAHIM SR. (NPI# 1396017984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396017984 |
| Entity Type | Individual |
| Full Name | ABBAS M.B IBRAHIM SR. |
| Practice Address |
12935 S Gregory Street Blue Island IL 60406 |
| Mailing Address |
10600 Brooks Lane Chicago Ridge IL 60415 |
| Practice Telephone | 7085972000 |
| Mailing Telephone | 7087173841 |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
238.000314 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
12935 S GREGORY STREET |
| City | BLUE ISLAND |
| State | IL |
| Zip Code | 60406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1942842810 | Blue Island Smiles PC | Dentist | 12059 Western Avenue, Blue Island, IL 60406 | 2019-10-12 |
| 1609438738 | Maisha Safford | Developmental Therapist | 2262 W. 120th Place, Blue Island, IL 60406 | 2019-06-28 |
| 1891279709 | Renjith Thomas | Physical Therapy Assistant | Therapy Department, 1546 W Water Stret, Blue Island, IL 60406 | 2018-09-18 |
| 1982182994 | Lifehouse Health Group,llc | Clinic/Center | 14127 Levitt Ave, Dixmoor, IL 60406 | 2018-08-01 |
| 1063923159 | Sarah Lynn Presser | Speech-Language Pathologist | 2975 W Broadway, Blue Island, IL 60406 | 2017-10-17 |
| 1174070676 | Aunt Martha's Youth Service Center | Clinic/Center | 12139 S. Western Ave, Blue Island, IL 60406 | 2016-09-01 |
| 1427429141 | Pamela Kilcrease | Case Manager/Care Coordinator | 2247 119th Street, Apt 6, Blue Island, IL 60406 | 2015-10-08 |
| 1639587025 | D2 Dental At Oak Street, P.C. | Dentist | 3046 West 127th Street, Blue Island, IL 60406 | 2014-07-29 |
| 1700299658 | Daniel Ahrens | Optometrist | 13114 S Western Ave, Blue Island, IL 60406 | 2014-06-09 |
| Find all providers in zip 60406 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
| Find all providers with the same taxonomy | ||||
| City | BLUE ISLAND |
| Zip Code | 60406 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.