Healthcare Provider Details

I. General information

NPI: 1124042288
Provider Name (Legal Business Name): NASHWAN Y YOUSIF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W AVON RD STE 7
ROCHESTER HILLS MI
48307-2760
US

IV. Provider business mailing address

PO BOX 4304
TROY MI
48099-4304
US

V. Phone/Fax

Practice location:
  • Phone: 248-693-8634
  • Fax: 248-693-8644
Mailing address:
  • Phone: 248-693-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080432
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301080432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: