Healthcare Provider Details

I. General information

NPI: 1386858603
Provider Name (Legal Business Name): RAED HIKMET-HABIB YOUSIF MD , MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 LEGACY PKWY
LANSING MI
48911-4265
US

IV. Provider business mailing address

512 WEST ABBEY MILL DRIVE SE
ADA MI
49301
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 248-719-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301078304
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301078304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: