Basic Information
| Provider Information | |||||||||
| NPI: | 1174569859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNA | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 830605 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352830605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057862776 | ||||||||
| FaxNumber: | 2057866227 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 PRINCETON AVE SW | ||||||||
| Address2: | POB III, SUITE 200A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057862776 | ||||||||
| FaxNumber: | 2057866227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 00027426 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 27426 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | BH9777535 | 01 | AL | FEDERAL DEA | OTHER | STATE LICENSE | 01 | AL | 00027426 | OTHER |