| Doctor Name: | DR. KAISSAR S IBRAHIM |
| NPI Number: | 1528305026 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 14686 |
| Business Practice Address: | 1435 Salter Path Rd Unit F5 Atlantic Beach, NC - 285125903 |
| Business Phone Number: | 2526224910 |
| Business Fax Number: | 4342936914 |
| Mailing Address: | Po Box 2859, ATLANTIC BEACH |
| State: | NC |
| Postal Code: | 285122859 |
| Phone Number: | 2526224910 |
| Fax Number: | 4342936914 |
| NPI Enumeration Date: | 01/03/2013 |
| NPI Last Update Date: | 01/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 14686 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |