Healthcare Provider Details

I. General information

NPI: 1386574028
Provider Name (Legal Business Name): DR. JONATHAN GEORGE YOUSIF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD. SUITE 155
DETROIT MI
48236
US

IV. Provider business mailing address

22201 MOROSS RD STE 155
DETROIT MI
48236-2152
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax:
Mailing address:
  • Phone: 248-469-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603003
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: