Healthcare Provider Details

I. General information

NPI: 1962912592
Provider Name (Legal Business Name): SAAD IMAD YOUSIF I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31201 CHICAGO RD S
WARREN MI
48093-5527
US

IV. Provider business mailing address

1981 HAMMAN DR
TROY MI
48085-5070
US

V. Phone/Fax

Practice location:
  • Phone: 248-712-4266
  • Fax: 248-712-4381
Mailing address:
  • Phone: 586-344-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: