Basic Information
| Provider Information | |||||||||
| NPI: | 1801081948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDULRAHMAN | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 S ZINTEL WAY | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423627 | ||||||||
| FaxNumber: | 5099422268 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 S ZINTEL WAY | ||||||||
| Address2: | KADLEC CLINIC - KENNEWICK PRIMARY CARE | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423125 | ||||||||
| FaxNumber: | 5097832167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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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 | 208000000X | MD60105626 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | MD60105626 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0306281 | 01 | WA | L&I NUMBER WA STATE | OTHER | 1801081948 | 05 | WA | MEDICAID | 500625216 | 01 | OR | OREGON MEDICAID | OTHER |