Provider Demographics
NPI:1972796290
Name:IBRAHIM, IRFAN M (PT DPT)
Entity type:Individual
Prefix:
First Name:IRFAN
Middle Name:M
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S BODIN ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3913
Mailing Address - Country:US
Mailing Address - Phone:312-730-4593
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1226 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2740
Practice Address - Country:US
Practice Address - Phone:312-730-4593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016762225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist