Healthcare Provider Details

I. General information

NPI: 1437372976
Provider Name (Legal Business Name): DHIA LOUIS YOUSIF MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28437 GREENFIELD RD SUITE 102
SOUTHFIELD MI
48076-3045
US

IV. Provider business mailing address

28437 GREENFIELD RD SUITE 102
SOUTHFIELD MI
48076-3045
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-5888
  • Fax: 248-557-5877
Mailing address:
  • Phone: 248-557-5888
  • Fax: 248-557-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301048281
License Number StateMI

VIII. Authorized Official

Name: DR. DHIA LOUIS YOUSIF
Title or Position: OWNER
Credential: MD
Phone: 248-557-5888