MEDICARE: DR. KABIR A YOUSUF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D65777	ME
2	207RC0000X	Cardiovascular Disease Physician	D0065777	MD
3	207RC0000X	Cardiovascular Disease Physician	ME159189	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174595763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KABIR A YOUSUF MD

Provider Business Mailing Address
First Line	:	PO BOX 746652
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6652
Country	:	US
Telephone Number	:	904-720-0599
Fax Number	:	904-376-4036

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY DR STE 320
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8503
Country	:	US
Telephone Number	:	904-224-5185
Fax Number	:	904-278-7284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	11/04/2022

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Directions to “ DR. KABIR A YOUSUF MD” Practice Location

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