Healthcare Provider Details

I. General information

NPI: 1447297551
Provider Name (Legal Business Name): WALID KHALED YASSIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST FL 1
DETROIT MI
48201-2119
US

IV. Provider business mailing address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5227
  • Fax: 313-745-5596
Mailing address:
  • Phone: 313-745-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number4301091249
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301091249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: