Healthcare Provider Details

I. General information

NPI: 1306078662
Provider Name (Legal Business Name): YOUSIF T. ISMAIL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

4855 QUARTON RD
BLOOMFIELD HILLS MI
48301-1029
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3000
  • Fax:
Mailing address:
  • Phone: 248-974-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301094108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: