| Dr Ibrahim A Mourad, MD | |
|
19550 E 39th St S, Suite 400, Independence, MO 64057-2303 | |
| (816) 254-4800 | |
| (816) 254-4641 |
| Full Name | Dr Ibrahim A Mourad |
|---|---|
| Gender | Male |
| Speciality | Hospitalist |
| Location | 19550 E 39th St S, Independence, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164497525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208M00000X | Hospitalist | 036-147746 (Illinois) | Primary |
| 208M00000X | Hospitalist | 2009021594 (Missouri) | Secondary |
| 207R00000X | Internal Medicine | 04-34405 (Kansas) | Secondary |
| Entity Name | Saint Lukes Physician Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093263717 PECOS PAC ID: 3577476894 Enrollment ID: O20031111000818 |
| Entity Name | Prime Healthcare Kansas City - Physician Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427449487 PECOS PAC ID: 7315267325 Enrollment ID: O20150514001835 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Ibrahim A Mourad, MD 4500 Memorial Dr, Belleville, IL 62226-5360 Ph: (618) 257-6220 | Dr Ibrahim A Mourad, MD 19550 E 39th St S, Suite 400, Independence, MO 64057-2303 Ph: (816) 254-4800 |
Swapna Chebrolu, Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 19550 E 39th Street, Independence, MO 64057 Phone: 816-698-8158 | |
Jayne Lora Opena Bumgarner, MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 4801 S Cliff Ave, Suite 300, Independence, MO 64055 Phone: 816-251-5200 Fax: 816-251-5299 |