Healthcare Provider Details

I. General information

NPI: 1134060593
Provider Name (Legal Business Name): MICHAEL SAMY YOUSSEF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1100 BLYTHE BLVD
CHARLOTTE NC
28203-5814
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-4457
  • Fax: 704-355-4442
Mailing address:
  • Phone: 704-355-4457
  • Fax: 704-355-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: