=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225071665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTENSIVE PULMONOLOGY & INTERNAL MEDICINE P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14555 LEVAN SUITE 404
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-462-1233
-----------------------------------------------------
Fax | 734-462-3044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14555 LEVAN SUITE 404
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-462-1233
-----------------------------------------------------
Fax | 734-462-3044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MOHAMMAD JAVAID YOUSUF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 734-462-1233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 054509
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------