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MARYO IBRAHIM
NPI 1255078366
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since May 19, 2022PECOS Enrolled
4201 SAINT ANTOINE ST STE 8D, DETROIT, MI 48201(313) 577-1245 Get Directions Write a Review

NPPES record last updated: May 19, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Maryo Ibrahim NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARYO IBRAHIM (NPI 1255078366) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since May 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1255078366
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMARYO IBRAHIM
Location Address4201 SAINT ANTOINE ST STE 8DDetroit, MI 48201-2153
Mailing Address1904 Meharry BlvdNashville, TN 37208-2900
Phone(313) 577-1245
Sole ProprietorYes
Enumeration DateMay 19, 2022
NPPES CertifiedMay 19, 2022
✔ NPI 1255078366 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4201 SAINT ANTOINE ST STE 8D, Detroit, MI 48201
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Maryo Ibrahim is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MASOUMEH KHOSRAVIARDAKANI NP
Nurse Practitioner (Acute Care)
4201 SAINT ANTOINE ST STE 8D
DETROIT, MI 48201
Wayne County (313) 745-4275
DR. JACOB RUBE MD
Psychiatry & Neurology (Neurology)
4201 SAINT ANTOINE ST STE 8D
DETROIT, MI 48201
Wayne County (313) 745-4275
MORGAN AGUIRRE DO
Psychiatry & Neurology (Neurology)
4201 SAINT ANTOINE ST STE 8D
DETROIT, MI 48201
Wayne County (313) 745-4275

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maryo Ibrahim's NPI number?

The NPI number for Maryo Ibrahim is 1255078366. It was assigned to this individual provider in the NPPES registry on May 19, 2022.

Where is Maryo Ibrahim located?

Maryo Ibrahim practices at 4201 Saint Antoine St Ste 8D, Detroit, MI 48201. The listed phone number is (313) 577-1245.

What is Maryo Ibrahim's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Maryo Ibrahim enrolled in Medicare?

Yes. Maryo Ibrahim is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Maryo Ibrahim was last updated on May 19, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.