Healthcare Provider Details

I. General information

NPI: 1700261336
Provider Name (Legal Business Name): MUNIRA A YUSUF MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 LAMY LN
MONROE LA
71201-3737
US

IV. Provider business mailing address

2829 W DEBORAH DR
MONROE LA
71201-1919
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MUNIRA YUSUF
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 318-322-7999