MEDICARE: MISS MAYSOUN YOSSEF EL JAROUCHE PA-C

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	363AM0700X	Medical Physician Assistant	004313	OH

General Provider Information

NPI Number	:	1487047379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MAYSOUN YOSSEF EL JAROUCHE PA-C

Provider Business Mailing Address
First Line	:	5532 WADSWORTH DR
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-3750
Country	:	US
Telephone Number	:	419-250-9273
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 W WOOSTER ST STE 107
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-2646
Country	:	US
Telephone Number	:	419-373-7692
Fax Number	:	419-373-4198

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

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	03/17/2015

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