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General NPI Number Information
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NPI Number | 1023959434
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Entity Type | Organization
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Legal Business Name | ETHOS MEDICAL PLLC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 3419 NOBLE DR
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City | WOODRIDGE
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State | IL
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Zip | 60517-1417
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Country | US
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Telephone | 607-425-8381
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Fax |
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Provider Business Mailing Address
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Address Line | 3419 NOBLE DR
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City | WOODRIDGE
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State | IL
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Zip | 60517-1417
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Country | US
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Telephone | 607-425-8381
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMER YUSAF
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Credential | MD
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Telephone | 607-425-8381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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