Provider Demographics
NPI:1538439435
Name:IBRAHIM S UMAR M P C
Entity type:Organization
Organization Name:IBRAHIM S UMAR M P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:SULEMAN
Authorized Official - Last Name:UMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-922-9182
Mailing Address - Street 1:4200 N CLOVERLEAF DR
Mailing Address - Street 2:SUITE N
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6436
Mailing Address - Country:US
Mailing Address - Phone:636-922-9182
Mailing Address - Fax:636-922-9183
Practice Address - Street 1:4200 N CLOVERLEAF DR
Practice Address - Street 2:SUITE N
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6436
Practice Address - Country:US
Practice Address - Phone:636-922-9182
Practice Address - Fax:636-922-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8426261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care