Healthcare Provider Details

I. General information

NPI: 1013935568
Provider Name (Legal Business Name): YOUSIF H GORIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15351 W NINE MILE RD
OAK PARK MI
48237
US

IV. Provider business mailing address

15351 W NINE MILE RD
OAK PARK MI
48237
US

V. Phone/Fax

Practice location:
  • Phone: 248-968-9500
  • Fax: 248-968-9502
Mailing address:
  • Phone: 248-968-9500
  • Fax: 248-968-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301034445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: