Provider Demographics
NPI:1679152342
Name:MIKHAIL, IBRAM
Entity type:Individual
Prefix:MR
First Name:IBRAM
Middle Name:
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37838 CARPATHIA BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3859
Mailing Address - Country:US
Mailing Address - Phone:586-662-6372
Mailing Address - Fax:
Practice Address - Street 1:31020 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1908
Practice Address - Country:US
Practice Address - Phone:248-589-1863
Practice Address - Fax:248-589-1896
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303022112183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician