| Doctor Name: | DR. ROSE MOHSEN IBRAHIM |
| NPI Number: | 1982675070 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 4301046478 |
| Business Practice Address: | 13739 S Huron River Dr Romulus, MI - 481743628 |
| Business Phone Number: | 7349410895 |
| Business Fax Number: | 7349411203 |
| Mailing Address: | 1598 Old Chatham Dr, BLOOMFIELD HILLS |
| State: | MI |
| Postal Code: | 483041040 |
| Phone Number: | 2483381939 |
| Fax Number: | 2483382127 |
| NPI Enumeration Date: | 01/28/2006 |
| NPI Last Update Date: | 09/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301046478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |