Healthcare Provider Details

I. General information

NPI: 1891135893
Provider Name (Legal Business Name): YOUSIF ISMAIL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 10/11/2018
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: 248-974-2511
  • 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 Number
License Number State

VIII. Authorized Official

Name: DR. YOUSIF T ISMAIL
Title or Position: OWNER / PRESIDENT
Credential: M.D.
Phone: 248-974-2511