Healthcare Provider Details

I. General information

NPI: 1699487280
Provider Name (Legal Business Name): OSMAN AHMED YOUSUF SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 MCKENNA BLVD APT 407
MADISON WI
53719-2274
US

IV. Provider business mailing address

1218 MCKENNA BLVD APT 407
MADISON WI
53719-2274
US

V. Phone/Fax

Practice location:
  • Phone: 206-816-0103
  • Fax:
Mailing address:
  • Phone: 206-816-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: