Healthcare Provider Details

I. General information

NPI: 1558381137
Provider Name (Legal Business Name): YOUSSEF N SOLOMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE DEVELOPMENTAL CENTER, WEST 6TH STREET GRAFTON VA CLINIC
GRAFTON ND
58237-2036
US

IV. Provider business mailing address

1520 WESTERN AVE
GRAFTON ND
58237-2036
US

V. Phone/Fax

Practice location:
  • Phone: 701-352-4059
  • Fax:
Mailing address:
  • Phone: 701-352-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4880
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: