Healthcare Provider Details

I. General information

NPI: 1841249760
Provider Name (Legal Business Name): A. HAJYOUSEF, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 KIMOLE LN SUITE B-1
ADRIAN MI
49221-1491
US

IV. Provider business mailing address

901 KIMOLE LN SUITE B-1
ADRIAN MI
49221-1491
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-6733
  • Fax: 517-263-7148
Mailing address:
  • Phone: 517-263-6733
  • Fax: 517-263-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ABDASSALAM HAJYOUSEF
Title or Position: PRESIDENT
Credential: MD
Phone: 517-263-6733