Basic Information
| Provider Information | |||||||||
| NPI: | 1164497525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOURAD | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182576220 | ||||||||
| FaxNumber: | 6182576679 | ||||||||
| Practice Location | |||||||||
| Address1: | 19550 E 39TH ST S | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162544800 | ||||||||
| FaxNumber: | 8162544641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 2009021594 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 036-147746 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.