Healthcare Provider Details

I. General information

NPI: 1790715480
Provider Name (Legal Business Name): YEHIA I ELSAFY M D P L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 MILITARY ST BUILDING #1
PORT HURON MI
48060-6692
US

IV. Provider business mailing address

4296 GRATIOT AVE
PORT HURON MI
48060-1599
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-6680
  • Fax: 810-985-6809
Mailing address:
  • Phone: 810-985-6680
  • Fax: 810-985-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301045260
License Number StateMI

VIII. Authorized Official

Name: DR. YEHIA IBRAHAM ELSAFY
Title or Position: OWNER
Credential: M.D.
Phone: 810-985-6680