MEDICARE: MOHAMMAD YOUSEF ABUSAMMOUR

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1336916329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD YOUSEF ABUSAMMOUR

Provider Business Mailing Address
First Line	:	5001 GOLDEN TRIANGLE BLVD APT 420
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7443
Country	:	US
Telephone Number	:	682-841-2603
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 GOLDEN TRIANGLE BLVD APT 420
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7443
Country	:	US
Telephone Number	:	682-841-2603
Fax Number	:

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

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	12/12/2023

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