Healthcare Provider Details

I. General information

NPI: 1649206095
Provider Name (Legal Business Name): KHURSHID YOUSUF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/12/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 LANIER RD STE 201
MADISON AL
35758-2632
US

IV. Provider business mailing address

PO BOX 2324
BIRMINGHAM AL
35201-2324
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-6488
  • Fax: 256-428-0468
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number18192
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: