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General NPI Number Information
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NPI Number | 1396360848
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Entity Type | Individual
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Provider Name | SHIRIN YUSUBOV MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 975 PORT WASHINGTON RD
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City | GRAFTON
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State | WI
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Zip | 53024-9201
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Country | US
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Telephone | 262-329-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 84720
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.154915
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301507357
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License Number State | MI
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