| Doctor Name: | DR. FADI IBRAHIM |
| NPI Number: | 1033159629 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | A93586 |
| Business Practice Address: | 150 Collins St Memphis, TN - 381123814 |
| Business Phone Number: | 9015267444 |
| Business Fax Number: | 9015260791 |
| Mailing Address: | 7550 Crystal Lake Dr, CORDOVA |
| State: | TN |
| Postal Code: | 380168771 |
| Phone Number: | 9015267444 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | A93586 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |