Provider Demographics
NPI:1538193008
Name:IBRAHIM, HASSAN NIMER (MB, BS)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:NIMER
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MB, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:411 N WASHINGTON AVE STE 6000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1789
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6988
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3533207RN0300X, 207RN0300X
MN39645207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374116701Medicaid
TXR3533OtherTX LICENSE
MN12G01IBOtherBCBS
MN125093OtherUCARE
MN31-00019OtherMEDICA CHOICE
MN939317000Medicaid
MNHP28981OtherHEALTHPARTNERS
MN31-00005OtherMEDICA PRIMARY
TX374116701Medicaid
MNHP28981OtherHEALTHPARTNERS
MN390000208Medicare ID - Type UnspecifiedMEDICARE